The association between novel clinical factors and gastrointestinal bleeding among patients supported with continuous‐flow left ventricular assist device therapy

• Published in: Journal of cardiac surgery Vol. 34; no. 6; pp. 453 - 462
• Main Authors: Thohan, Vinay, Shi, Yang, Rappelt, Matthew, Yousefzai, Rayan, Sulemanjee, Nasir Z., Hastings, Thomas E., Cheema, Omar M., Downey, Frank, Crouch, John D.
• Format: Journal Article
• Language: English
• Published: United States 01.06.2019
• Subjects: advanced heart failure; continuous‐flow left ventricular assist device; gastrointestinal abnormalities; gastrointestinal bleeding; risk factors; gastrointestinal abnormalities; risk factors; advanced heart failure; continuous-flow left ventricular assist device; gastrointestinal bleeding
• ISSN: 0886-0440; 1540-8191; 1540-8191
• DOI: 10.1111/jocs.14062

Background This study explores novel preimplantation risk factors associated with gastrointestinal bleeding (GIB) after continuous‐flow left ventricular assist device (CF‐LVAD) implantation. CF‐LVAD therapy implantation for patients with advanced heart failure is associated with a 20% to 40% incidence of GIB. Methods This study includes patients receiving CF‐LVAD at a quaternary medical center from 2006 to 2014 (n = 254). The primary endpoint was GIB within 12 months after implantation; the secondary outcome was 3‐year all‐cause mortality. The Student t test or the χ2 test compared continuous or categorical variables. Competing risks analysis calculated the cumulative incidence of GIB postimplantation. Cox proportional hazards model was used for univariate/multivariate models predicting GIB. Results Sixty‐four patients had GIB, with incidence rates at 1, 3, and 12 months of 11.8%, 19.3%, and 25.2%, respectively. Endoscopy revealed no identified source of bleeding in 41%; 33% of lesions were localized in the upper gastrointestinal tract, with the bulk (39%) categorized as vascular. Patients with prior gastrointestinal abnormalities (n = 98) had a greater risk of GIB post‐CF‐LVAD (HR 1.85 [1.11‐3.09]; P = 0.02) than those with normal gastrointestinal evaluation results (n = 45) and those without preimplantation gastrointestinal evaluation (n = 111). Baseline blood urea nitrogen, chronic obstructive pulmonary disease, and prior percutaneous coronary intervention were statistically associated with post‐CF‐LVAD GIB. The presence of GIB within 12 months of CF‐LVAD implantation was associated with an increased risk of 3‐year all‐cause mortality (HR 2.57 [1.57‐4.15]; P < 0.01). Conclusions First‐year GIB is associated with increased mortality post‐CF‐LVAD. We advocate a closer examination of several GIB risk factors when evaluating CF‐LVAD candidates.