Gastrointestinal Bleeding in Patients Supported with Left Ventricular Assist Devices: The Journey from Bridging to Destination

Mohamed, Mohamed Salah; Shehadah, Ahmed; Hashem, Anas; Chand, Swati; Bapaye, Jay; Khalouf, Amani; Rai, Devesh; Peter, Shajan

doi:10.1016/j.amjcard.2023.05.059

Cited by 3 publications

(3 citation statements)

References 41 publications

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“…1,3,4,6,7,10,22,23 Danazol, an androgen, is thought to reduce the risk of GIB due to increased factor VIII levels/increased vWF activity and decreased endothelial permeability. 4,10,11 Danazol has been shown to reduce monthly readmissions for GIB and need for blood transfusion. 25 The literature is otherwise limited and concerns for drug-induced liver toxicity require further evaluation of danazol in the management of refractory GIB.…”

Section: Discussionmentioning

confidence: 99%

“…Angiogenesis occurs via the induction of tyrosine kinase activating factors including vascular endothelial growth factor (VEGF), causing formation of fragile AVMs that are prone to bleeding. [1][2][3][4][5][6][7][8][9][10][11] In addition, high shear stress on blood as it passes through the LVAD is thought to lead to protein unraveling and break down of von Willebrand factor (vWF), leading to acquired deficiency and potential upregulation of angiogenesis. 1,2,4,[6][7][8]10 GI angiodysplasia (GIAD)-related bleeding in this population leads to increased hospitalizations, lengths of hospital stay, blood transfusions, and endoscopic procedures.…”

Section: Introductionmentioning

confidence: 99%

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Inhibition of angiogenesis in the management of refractory gastrointestinal bleeding in patients with LVAD support

Inglis,

Asleh,

Iyer

et al. 2023

Artificial Organs

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BackgroundGastrointestinal bleeding (GIB) in patients with continuous flow left ventricular assist devices (CF‐LVADs) is often related to GI angiodysplasia (GIAD). We previously reported data on VEGF inhibition with IV bevacizumab in the treatment of LVAD‐associated GIAD bleeding, and now present follow‐up data on patients treated with IV bevacizumab and/or low‐dose oral pazopanib.MethodsAll consecutive adult patients with LVAD‐associated GIB from GIAD treated with bevacizumab or pazopanib, from July 20, 2017 to June 22, 2022, were included in the analysis. Data on hospitalizations, GI endoscopic procedures, and blood transfusions were obtained from first admission for GIB up to a median of 35.7 months following treatment initiation (range 1.3–59.8 months).ResultsEleven patients (91% male, mean 69.5 ± 8.9 years) were included. Eight patients (73%) received IV bevacizumab, two patients (18%) received oral pazopanib, and one patient (9%) received bevacizumab followed by pazopanib therapy. We observed a significantly decreased number of annualized hospitalizations for GIB (median difference − 2.87, p = 0.002), blood transfusions (median difference − 20.9, p = 0.01), and endoscopies (median difference − 6.95, p = 0.007) in patients pre‐ and post‐anti‐angiogenic therapy (bevacizumab and/or pazopanib). Similarly, a significant improvement in these clinical outcomes was noted in the bevacizumab group with decreased annualized hospitalizations (median difference − 2.75, p = 0.014), blood transfusions (median difference − 24.5, p = 0.047), and number of endoscopies (median differences −6.88, p = 0.006).ConclusionAnti‐angiogenic therapy with IV bevacizumab and/or low‐dose oral pazopanib appears to provide benefits in patients with LVAD‐associated GIB with reduced hospitalizations, blood transfusions, and need for GI endoscopic procedures.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Inhibition of angiogenesis in the management of refractory gastrointestinal bleeding in patients with LVAD support

Inglis,

Asleh,

Iyer

et al. 2023

Artificial Organs

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“…GI bleeding is one of the adverse events that has a higher incidence in continuous flow left ventricular assist device (CF ‐LVAD) therapy 2 . Several theories for the incidence of GI bleeding have been investigated; for example, acquired von Willebrand syndrome, coagulopathy, and treatment with antithrombotic therapy 3 . Furthermore, Demirozu et al reported that in 30% of CF‐LVAD patients who had a GI bleeding history, there was an association with an arteriovenous malformation (AVM) 4 .…”

Section: Introductionmentioning

confidence: 99%

Preservation of pulsatility with universal ventricular assist device: In vitro assessment for biventricular support

Kuroda,

Miyagi,

Polakowski

et al. 2023

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BackgroundThe objective of this study was to assess the pulsatility preservation capability of the universal ventricular assist device (UVAD) when used as a biventricular assist device (BVAD). This evaluation was conducted through an in vitro experiment, utilizing a pulsatile biventricular circulatory mock loop.MethodsTwo UVAD pumps were tested in a dual setup (BVAD) in the circulatory model with the simulated conditions of left heart failure (HF), right HF, and moderate/severe biventricular HF (BHF). The total flow, aortic pulse pressure, the pulse augmentation factor (PAF), the energy‐equivalent pressure (EEP), and the surplus hemodynamic energy (SHE) were observed at various pump speeds to evaluate the pulsatility.ResultsThe aortic pulse pressure increased from the baseline (without pump) in all simulated hemodynamic conditions. The PAF ranged from 17%–35% in healthy, left HF, right HF, and mild BHF conditions, with the highest PAF of 90% being observed in the severe BHF condition. The EEP correlated with LVAD flow in all groups (R2 = 0.87–0.97) and increased from the baseline in all cases. The SHE peaked at approximately 5–6 L/min of LVAD support and was likely to decrease at higher LVAD pump flow. The largest decrease in SHE from the baseline, 53%, was observed in the mild BHF conditions with the highest LVAD and RVAD support.ConclusionsThe UVAD successfully demonstrated the ability to preserve pulsatility in vitro, and to optimize the cardiac output, as an isolated circulatory support device option (RVAD or LVAD) and when used for BVAD support.

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Management of Obscure Gastrointestinal Bleeding

Singh,

Mohan,

Adler

2024

Am J Gastroenterol

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Gastrointestinal Bleeding in Patients Supported with Left Ventricular Assist Devices: The Journey from Bridging to Destination

Cited by 3 publications

References 41 publications

Inhibition of angiogenesis in the management of refractory gastrointestinal bleeding in patients with LVAD support

Inhibition of angiogenesis in the management of refractory gastrointestinal bleeding in patients with LVAD support

Preservation of pulsatility with universal ventricular assist device: In vitro assessment for biventricular support

Management of Obscure Gastrointestinal Bleeding

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