Gastrointestinal bleeding with the HeartMate II left ventricular assist device

Morgan, Jeffrey A.; Paone, Gaetano; Nemeh, Hassan; Henry, Scott E.; Patel, Rosan; Vavra, Jessica; Williams, C.; Lanfear, David E.; Tita, Cristina; Brewer, Robert J.

doi:10.1016/j.healun.2012.02.015

Cited by 143 publications

(97 citation statements)

References 35 publications

(25 reference statements)

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“…Other investigators have proposed that the high rate of bleeding with the use of a continuous-flow LVAD is from a defect in thrombogenesis brought on by non-pulsatile blood flow [19][20][21][22][23][24][25][26][27]. Patients can develop decreased levels of high molecular weight von Willebrand factor (vWF), which are critical for platelet adhesion.…”

Section: Discussionmentioning

confidence: 99%

The Incidence, Predictors and Outcomes of Gastrointestinal Bleeding in Patients with Left Ventricular Assist Device (LVAD)

et al. 2015

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GIB in LVAD patients is common, occurring primarily in the upper GI tract. Upper endoscopy is the preferred strategy though lower endoscopy is also recommended for a full workup. Endoscopy can identify GIB lesions in about 50% of patients, but re-bleeding is common. Right ventricular dysfunction and post-LVAD ejection fraction >30% are associated with higher GIB rates. Higher pulsatility index is associated with lower GIB rates. Reduction in pump speed is a potential strategy for managing and preventing GIB.

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Section: Discussionmentioning

confidence: 99%

The Incidence, Predictors and Outcomes of Gastrointestinal Bleeding in Patients with Left Ventricular Assist Device (LVAD)

et al. 2015

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“…In HMII patients with GI bleeding, Jabbar et al 23 reported a rebleed rate of 43% (19/44 patients), whereas Morgan et al 24 observed a rebleed rate of 21% (4/19 patients). Goldstein et al 19 described a 34% rebleed rate (20/59) in CF-LVAD patients with a history of previous GI bleeding.…”

Section: Discussionmentioning

confidence: 99%

Multicenter Evaluation of Octreotide as Secondary Prophylaxis in Patients With Left Ventricular Assist Devices and Gastrointestinal Bleeding

Shah

Gunda

Emani

et al. 2017

Circ: Heart Failure

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BACKGROUND:Gastrointestinal (GI) bleeding is one of the most common complications after continuous-flow left ventricular assist device implantation. More than one third of patients with incident bleed go on to develop recurrent GI bleeding. Octreotide, a somatostatin analog, is proposed to reduce the risk of recurrent GI bleeding in this population. METHODS AND RESULTS:This multicenter, retrospective analysis evaluated 51 continuous-flow left ventricular assist device patients who received secondary prophylaxis with octreotide after their index GI bleed from 2009 to 2015. All patients had a hospitalization for GI bleed and received octreotide after discharge. Patient demographics, medical and medication history, and clinical characteristics of patients who rebled after receiving octreotide were compared with non-rebleeders. These data were also compared with matched historical control patients previously enrolled in the HMII (HeartMate II) clinical trials, none of whom received octreotide, to provide a context for the bleeding rates. Twelve patients (24%) who received secondary octreotide prophylaxis developed another GI bleed, whereas 39 (76%) did not. There were similar intergroup demographics; however, significantly more bleeders had a previous GI bleeding history before left ventricular assist device placement (33% versus 5%; P=0.02) and greater frequency of angiodysplasia confirmed during endoscopy (58% versus 23%; P=0.03). Fewer patients in this study experienced a recurrent GI bleed compared with a matched historical control group that did not receive octreotide (24% versus 43%; P=0.04). CONCLUSIONS:Patients with continuous-flow left ventricular assist device receiving secondary prophylaxis with octreotide had a significantly lower GI bleed recurrence compared with historical controls not treated with octreotide. Additional prospective studies are needed to confirm these data.

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“…Similar to the aforementioned anticoagulation management, this strategy, aimed at decreasing complications, yielded unintended consequences, and, while permitting greater native heart function, it was found to decrease flow through the pump and increase the risk of subsequent pump thrombosis [16]. Lastly, and arguably most significantly, the unique interaction of the patient's blood and the blood-contacting surfaces of the LVAD have been shown to result in de novo complications such as acquired Von Willebrand disease, which has been shown to predispose to gastrointestinal bleeding [17,18], which, as mentioned above, may then increase the risk of subsequent thromboembolic events. Mechanical issues related to the pump have a demonstrated association with pump thrombosis [19].…”

Section: Potential Causes Of the Problemmentioning

confidence: 99%

Management of Pump Thrombosis in Patients with Left Ventricular Assist Devices

Stulak

Sharma

Maltais

2015

Am J Cardiovasc Drugs

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The gradual evolution of left ventricular assist device (LVAD) therapy has resulted in a durable option for patients as either a bridge to transplantation (BTT) or a destination therapy (DT). Outcomes with current continuous-flow devices continue to demonstrate significant patient benefit, not only in enhanced survival but also in improved functional capacity and quality of life. While the lessening of adverse events through time has resulted in more widespread adoption of this therapy, there continues to be unintended consequences, including, most notably, infection, bleeding, and thrombosis. Beginning in 2011, centers and collaborative groups began to observe a significant increase in the incidence of pump thrombosis with the HeartMate II LVAD (Thoratec Corp., Pleasanton, CA, USA). However, this clinical scourge is not limited to the HeartMate II, as the HeartWare Ventricular Assist System (HVAD; HeartWare Inc., Framingham, MA, USA) has also had these same issues, which led to pump modifications and the appreciation of more strict control of blood pressure and anticoagulation with this pump design. We review the current status of the field of mechanical circulatory support in its approach to diagnosis, management, and prevention of LVAD pump thrombosis.

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Gastrointestinal bleeding with the HeartMate II left ventricular assist device

Cited by 143 publications

References 35 publications

The Incidence, Predictors and Outcomes of Gastrointestinal Bleeding in Patients with Left Ventricular Assist Device (LVAD)

The Incidence, Predictors and Outcomes of Gastrointestinal Bleeding in Patients with Left Ventricular Assist Device (LVAD)

Multicenter Evaluation of Octreotide as Secondary Prophylaxis in Patients With Left Ventricular Assist Devices and Gastrointestinal Bleeding

Management of Pump Thrombosis in Patients with Left Ventricular Assist Devices

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