Abstract 17427: Cessation of Continuous Flow LVAD-induced Gastrointestinal Bleeding After Heart Transplantation
Objective: It is well established that continuous flow left ventricular assist device (CF LVAD) therapy induces gastrointestinal bleeding (GIB). What has been widely presumed but not documented to date is whether CF LVAD explantation at the time of transplantation halts this process.
Methods: A single-center retrospective review was conducted on patients who received CF LVAD from 2006 to 2016 and subsequently developed GIB, as defined by INTERMACS. Patients were divided into those who underwent transplantation and those who remained on CF LVAD, and compared for the rates of recurrent GIB if they had at least 1 year of follow-up.
Results: Of a total of 258 patients who received CF LVAD during the study period, there were total 88 episodes of GIB in 55 patients (22%, 0.32 events per patient year). Median time to first bleeding was 74 days, and arteriovenous malformation was the etiology in 24 patients (44%). Twenty-one patients who underwent transplantation and 19 patients who remained on the device formed the compared groups. The incidence of GIB during the first year on the device (1.14 events per patient year for the transplanted group vs. 1.16 events per patient year for the group remained on CF LVAD), sex (58% vs. 76% males, p = 0.22), etiology of heart failure (42% vs. 48% ischemic, p = 0.72), and device type (78% vs. 81% HeartMate II, p = 0.87) did not differ between the groups, while the transplanted group was younger (55 ± 10 vs. 63 ± 9 years, p = 0.02). In the group of 19 patients who remained on CF LVAD, 11 episodes of recurrent GIB occurred in 8 patients over 1 year follow-up (42%, 0.58 per patient year). In contrast, there was no recurrence of GIB in the group of 21 transplanted patients over 1 year after transplantation (p = 0.009, Figure 1).
Conclusions: This is the first documentation that transplantation effectively eliminates CF LVAD-induced GIB. Current guidelines recommending prioritization for transplant for patients who develop GIB after CF LVAD is justified.
Author Disclosures: K. Oh: None. O. Saeed: None. D. Goldstein: None. S.R. Patel: None. U.P. Jorde: None.
- © 2016 by American Heart Association, Inc.