Left Ventricular Assist Devices and Gastrointestinal Bleeding: A Narrative Review of Case Reports and Case Series

Islam, Sameer; Çevik, Cihan; Madonna, Rosalinda; Frandah, Wesam; Islam, Ebtesam; Islam, Sherazad; Nugent, Kenneth

doi:10.1002/clc.22096

Cited by 89 publications

(63 citation statements)

References 58 publications

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“…The abdominal aorta was chosen for the measurements because patients with PVADs typically do not suffer from gastrointestinal bleeding, whereas patients on continuous-flow VADs show a high incidence of such complication (8,11,22). Consequently, abdominal WI patterns under PVAD support should yield insight into what type of hemodynamic disturbance is acceptable in that region.…”

Section: Discussionmentioning

confidence: 99%

“…At these PS, the LV and PVAD waves seem to add or cancel each other in the peripheral circulation, resulting in a high or a low blood flow pulsatility, respectively. Blood flow pulsatility in VAD patients is important with respect to end-organ perfusion and adverse events such as gastrointestinal bleeding or peripheral vascular stiffening (8,9,11,29). Therefore, the long-term use of the PS between 40 and 60% should probably be avoided in PVADs until solid clinical data on safety and efficacy for various PS are available.…”

Section: Discussionmentioning

confidence: 99%

“…The impact of VADs on the hemodynamics and on the mechanical unloading of the heart has been analyzed previously (3,7,12,16,26). In cases where the duration of VAD support is in the order of years, its impact on the peripheral circulation and potentially induced structural changes (8,11,22) needs more research.…”

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confidence: 99%

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Effects of Thoratec pulsatile ventricular assist device timing on the abdominal aortic wave intensity pattern

Jahren

Amacher

Weber

et al. 2014

American Journal of Physiology-Heart and Circulatory Physiology

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Jahren SE, Amacher R, Weber A, Most H, Flammer SA, Traupe T, Stoller M, de Marchi S, Vandenberghe S. Effects of Thoratec pulsatile ventricular assist device timing on the abdominal aortic wave intensity pattern. Am J Physiol Heart Circ Physiol 307: H1243-H1251, 2014. First published August 22, 2014; doi:10.1152/ajpheart.00085.2014.-Arterial waves are seen as possible independent mediators of cardiovascular risks, and the wave intensity analysis (WIA) has therefore been proposed as a method for patient selection for ventricular assist device (VAD) implantation. Interpreting measured wave intensity (WI) is challenging, and complexity is increased by the implantation of a VAD. The waves generated by the VAD interact with the waves generated by the native heart, and this interaction varies with changing VAD settings. Eight sheep were implanted with a pulsatile VAD (PVAD) through ventriculoaortic cannulation. The start of PVAD ejection was synchronized to the native R wave and delayed between 0 and 90% of the cardiac cycle in 10% steps or phase shifts (PS). Pressure and velocity signals were registered, with the use of a combined Doppler and pressure wire positioned in the abdominal aorta, and used to calculate the WI. Depending on the PS, different wave interference phenomena occurred. Maximum unloading of the left ventricle (LV) coincided with constructive interference and maximum blood flow pulsatility, and maximum loading of the LV coincided with destructive interference and minimum blood flow pulsatility. We believe that noninvasive WIA could potentially be used clinically to assess the mechanical load of the LV and to monitor the peripheral hemodynamics such as blood flow pulsatility and risk of intestinal bleeding.arterial wave interference; heart-ventricular assist device interaction; pulsatility; ventricular assist device; wave intensity analysis VENTRICULAR ASSIST DEVICES (VADs) are clinically used blood pumps to treat end-stage heart failure (28). In addition to being used as a bridge-to-transplantation, the use of VADs as a bridge-to-recovery and as an alternative to heart transplantation is becoming increasingly important (14). The impact of VADs on the hemodynamics and on the mechanical unloading of the heart has been analyzed previously (3,7,12,16,26). In cases where the duration of VAD support is in the order of years, its impact on the peripheral circulation and potentially induced structural changes (8,11,22) needs more research.Wave intensity analysis (WIA) is a relatively new method to evaluate arterial wave transmission phenomena. WIA has received increased attention because arterial waves are seen as possible independent mediators of cardiovascular risks (10). WIA is based on conservation of mass and momentum in elastic vessels and uses the simultaneous measurement of arterial pressure and blood flow velocity (20, 31). Previously, WIA has been used to analyze the performance of intra-aortic balloon pumps (IABPs) (4, 5, 15, 17), para-aortic counterpulsation devices (18), or pusher-plate pulsatil...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Effects of Thoratec pulsatile ventricular assist device timing on the abdominal aortic wave intensity pattern

Jahren

Amacher

Weber

et al. 2014

American Journal of Physiology-Heart and Circulatory Physiology

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“…The main causes of the GI bleeding in these patients include the use of anticoagulant medications, the formation of arteriovenous malformations, loss of von Willebrand factor activity, and mucosal ischemia. 26 Pump thrombosis has been one of the common indications for pump exchange. Given the decrease in survival after each subsequent pump exchange, the prevention of pump thrombosis and pump malfunction are critical.…”

Section: Complications Of Lvads Therapymentioning

confidence: 99%

Updates on management of advanced heart failure

2017

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“…Tais condições extraordinárias podem causar danos ao sangue tais como hemólise, ativação de plaquetas, alteração da cascata da coagulação, trombose e embolia, redução da funcionalidade dos glóbulos brancos do sangue (leucócitos) e destruição do fator de von Willebrand (Dassanayaka et al, 2013), (Egger et al, 2013), (Islam et al, 2013), (Birschmann et al, 2014), (Bartoli et al, 2014a), (Bartoli et al, 2014b), (Bartoli et al, 2014c), (Restle et al, 2015).…”

Section: Suporte Circulatório Mecânicounclassified

Modelagem matemática da fluidodinâmica não-newtoniana e bifásica simplificada da hemólise induzida mecanicamente em sistemas de bombeamento centrífugo de sangue

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Left Ventricular Assist Devices and Gastrointestinal Bleeding: A Narrative Review of Case Reports and Case Series

Cited by 89 publications

References 58 publications

Effects of Thoratec pulsatile ventricular assist device timing on the abdominal aortic wave intensity pattern

Effects of Thoratec pulsatile ventricular assist device timing on the abdominal aortic wave intensity pattern

Updates on management of advanced heart failure

Modelagem matemática da fluidodinâmica não-newtoniana e bifásica simplificada da hemólise induzida mecanicamente em sistemas de bombeamento centrífugo de sangue

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