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

Abstract

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 χ 2 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 ; 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.

Initial endoscopic intervention is not associated with reduced risk of recurrent gastrointestinal bleeding in left ventricular assist device patients

“…“Unknown” was the most common location for all rGIB. Consistent with other studies these patients display a high rate of angioectasia lesions with the majority of bleeding located in the upper GI tract [ 29 ]. No statistically significant predictor of rGIB was noted within this heterogeneous group on multivariate analysis.…”

Prevalence, management, and outcomes of haemorrhagic events in left ventricular assist device recipients

“…In case of GI bleeding, there was a trend for an increased risk of death (HR 3.0, P = 0.05), probably because of lack of statistical power in our study. However, data in the literature remain discordant with studies showing an excess of mortality 14,17 and others not 7,18,19 . Most patients with a first episode had recurrences and more than 40% had more than three episodes leading to many rehospitalization and procedures.…”

Outcomes of gastrointestinal bleeding in patients with left ventricular assist devices: a tertiary care experience

“…Multiple algorithms have been proposed in the literature [28,32,33] for evaluation of gastrointestinal bleeding in LVAD patients; however, there is no standardized guideline for evaluation of these patients and data regarding screening high-risk patients for bleeding prior to LVAD placement are scarce. A recent study reviewed 64 gastrointestinal bleeding events in LVAD patients to evaluate risk of mortality after the index gastrointestinal bleeding event [34]. Their findings suggest increased mortality after ▶ Table 3 Cox proportional hazards multivariate models for the endpoint of all-cause mortality.…”