Gastrointestinal Angiodysplasia is Part of the Vascular Pathophysiology of Advanced Heart Failure

Patel, Snehal R.; Vukelic, S.; Kwah, Joann; Chinnadurai, T.; Saeed, Omar; Goldstein, Daniel J.; Jorde, Ulrich P.

doi:10.1016/j.healun.2019.01.324

Cited by 2 publications

(3 citation statements)

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“…28 A recently proposed theory, related to the pathophysiology of arteriovenous malformation-related bleeding in continuous-flow LVAD recipients, is that angiodysplasia may be part of the natural pathophysiology of advanced heart failure. Patel and colleagues 29 reported a significantly higher prevalence of angiodysplasia (P=0.009) in patients with advanced heart failure than in a control group. Clinically, our findings suggest that gastrointestinal bleeding may be encountered more frequently in LVAD recipients as the proportion of those who are older and have ICM grows.…”

Section: Discussionmentioning

confidence: 95%

Continuous-Flow Left Ventricular Assist Device Support in Patients with Ischemic Versus Nonischemic Cardiomyopathy

Chou

Critsinelis

Lamba

et al. 2021

Texas Heart Institute Journal

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To determine whether the cause of cardiomyopathy affects outcomes in patients who undergo continuous-flow left ventricular assist device support, we compared postimplant adverse events and survival between patients with ischemic and nonischemic cardiomyopathy. The inclusion criteria for the ischemic group were a history of myocardial infarction or revascularization (coronary artery bypass grafting or percutaneous coronary intervention), ≥75% stenosis of the left main or proximal left anterior descending coronary artery, or ≥75% stenosis of ≥2 epicardial vessels. From November 2003 through March 2016, 526 patients underwent device support: 256 (48.7%) in the ischemic group and 270 (51.3%) in the nonischemic group. The ischemic group was older (60.0 vs 50.0 yr), included more men than women (84.0% vs 72.6%), and had more comorbidities. More patients in the nonischemic group were able to have their devices explanted after left ventricular recovery (5.9% vs 2.0%; P=0.02). More patients in the ischemic group had gastrointestinal bleeding (31.2% vs 22.6%; P=0.03), particularly from arteriovenous malformations (20.7% vs 11.9%; P=0.006) and ulcers (16.4% vs 9.3%; P=0.01). Kaplan-Meier analysis revealed no difference in overall survival between groups (P=0.24). Older age, previous sternotomy, higher total bilirubin level, and concomitant procedures during device implantation independently predicted death (P ≤0.03), whereas cause of heart failure did not (P=0.08). Despite the similarity in overall survival between groups, ischemic cardiomyopathy was associated with more frequent gastrointestinal bleeding. This information may help guide the care of patients with ischemic cardiomyopathy who receive continuous-flow left ventricular assist device support.

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Section: Discussionmentioning

confidence: 95%

Continuous-Flow Left Ventricular Assist Device Support in Patients with Ischemic Versus Nonischemic Cardiomyopathy

Chou

Critsinelis

Lamba

et al. 2021

Texas Heart Institute Journal

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“…Interestingly, CVE rates are lower and this dreadful complication does not eventuate similarly in pediatric CF‐LVAD population. Although more studies are required to evaluate this finding, milder course of CVE in children with CF‐LVAD may be due to absence of chronic diseases such as hypertension and diabetes, relatively short course of end‐stage heart failure, and concomitant angiogenic dysregulation or angiodysplasia 17,18 …”

Section: Discussionmentioning

confidence: 99%

“…Although more studies are required to evaluate this finding, milder course of CVE in children with CF-LVAD may be due to absence of chronic diseases such as hypertension and diabetes, relatively short course of end-stage heart failure, and concomitant angiogenic dysregulation or angiodysplasia. 17,18 As a result, CF-LVADs which were initially designed for adult population are now used more frequently in children with lower rates of adverse events. In our cohort, 17 patients had never experienced CVE, and 9 patients were successfully bridged to transplant.…”

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confidence: 99%

Cerebrovascular events in children on intracorporeal continuous‐flow left ventricular assist devices

et al. 2020

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Continuous-flow intracorporeal left ventricular assist devices (CF-LVAD) are used more frequently in the pediatric population. One of the major complications of CF-LVAD is cerebrovascular events (CVEs). Limited information is available on this complication in pediatric patients. We hereby present our experience on CVEs in children under CF-LVAD support in our institution. A retrospective, single center review of 21 patients younger than 19 years of age who underwent CF-LVAD implantation between June 2014 and September 2018 was performed. Patients on biventricular support and extracorporeal devices were excluded. Cerebrovascular accidents (CVAs)-ischemic or hemorrhagic-were investigated. CVE was confirmed by brain computed tomographic scan. Of 21 pediatric patients, 11 were male. Mean BSA was 1.05 ± 0.41 m 2 and mean age was 11.05 ± 4.07 years. Dilated cardiomyopathy was the leading cause of heart failure. The patients were implanted with HeartWare hVAD (n = 19), HeartMate II (n = 1), and HeartMate 3 (n = 1). Mean support time was 421 ± 448 (18-1460) days. Target international normalized ratio was between 2.5 and 3.0. Nine (43%) patients underwent transplantation, one patient recovered with subsequent device explantation. Four (17%) patients were still on support. One patient (5%) died in the early postoperative period and six (28%) patients died on VAD support after a mean duration of 194 days. There were overall five cerebral hemorrhagic strokes in four patients (0.2 events per patient-year). CVA occurred between 250 and 1320 days (mean 600 days). No ischemic stroke was documented. Only one (20%) patient died after hemorrhagic stroke; the other three patients recovered and were discharged from the hospital with minor sequelae. Incidence of CVE in children on CF-LVAD is relatively low compared with adults on VAD and severity of stroke is milder than adult population.

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Gastrointestinal Angiodysplasia is Part of the Vascular Pathophysiology of Advanced Heart Failure

Cited by 2 publications

References 0 publications

Continuous-Flow Left Ventricular Assist Device Support in Patients with Ischemic Versus Nonischemic Cardiomyopathy

Continuous-Flow Left Ventricular Assist Device Support in Patients with Ischemic Versus Nonischemic Cardiomyopathy

Cerebrovascular events in children on intracorporeal continuous‐flow left ventricular assist devices

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