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Gastrointestinal Bleeding After HeartMate II or HVAD Implantation

Incidence, Location, Etiology, and Effect on Survival

Kawabori, Masashi*,†; Kurihara, Chitaru*,†,‡; Critsinelis, Andre C.*,†; Sugiura, Tadahisa*,†; Kaku, Yuji*,†; Civitello, Andrew B.*,†; Rosengart, Todd K.§; Morgan, Jeffrey A.*

doi: 10.1097/MAT.0000000000000998
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The number of patients on destination therapy is increasing as long-term survival on continuous-flow left ventricular assist device (CF-LVAD) therapy has improved. Gastrointestinal bleeding (GIB) is a common complication after CF-LVAD implantation, and its risk correlates with longer support time, emphasizing the importance of GIB management. The lower pulsatility of CF-LVADs may promote arteriovenous malformations, that amplify the bleeding risk. Here, we retrospectively analyzed the location, incidence, and survival effect of GIB events in Heartmate II (HM-II) and HVAD recipients to provide specific details regarding these complications. From November 2003 to March 2016, 526 patients with chronic heart failure underwent primary implantation of an HM-II (n = 403) or HVAD (n = 123) CF-LVAD at our center. Of the 526 patients, 140 (26.6%) had a GIB event (HM-II: n = 100; HVAD: n = 40), 92 (17.5%) had a single GIB event, and 48 (9.1%) had multiple GIB events (range: 2–9 events). HVAD recipients had a higher incidence of both upper and lower GIB events (p < 0.001 and P = 0.002, respectively) than HM-II recipients. Arteriovenous malformation was the most common etiology for GIB (50 patients/72 events); for this group, the average time-to-event was 300.4 days, the recurrence rate was 34%, and the 90-day and 1-year survival rates were 88.3% and 66.7%, respectively. Age at implantation was the only predictor of GIB. In conclusion, our study provides detailed information about GIB events associated with current CF-LVADs. Additional studies are required to evaluate strategies to reduce the incidence of GIB morbidity.

From the *Division of Cardiothoracic Transplantation and Circulatory Support, Baylor College of Medicine, Houston, Texas

Department of Cardiopulmonary Transplantation, the Center for Cardiac Support, Texas Heart Institute, Houston, Texas

Division of Cardiothoracic Surgery, Tokyo Metropolitan Geriatric Hospital, Institute of Gerontology, Tokyo, Japan

§Department of Surgery, Baylor College of Medicine, Houston, Texas.

Submitted for consideration June 2018; accepted for publication in revised form March 2019.

Disclosure: The authors have no conflicts of interest to report.

Correspondence: Chitaru Kurihara, Texas Heart Institute, Cooley 355N, 6770 Bertner Avenue, Houston, TX 77030. Email: chitaru1207@gmail.com.

Copyright © 2019 by the American Society for Artificial Internal Organs