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Risk Factors of Gastrointestinal Bleeding After Continuous Flow Left Ventricular Assist Device

Balcioglu, Ozlem*; Kemal, Hatice, S.; Ertugay, Serkan; Ozturk, Pelin; Engin, Yaprak§; Nalbantgil, Sanem; Engin, Cagatay; Yagdi, Tahir; Ozbaran, Mustafa

doi: 10.1097/MAT.0000000000000678
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This study aimed to compare von Willebrand factor (vWF) levels, ristocetin cofactor levels, platelet counts, aortic valve movements, and right heart failure (RHF) as risk factors of gastrointestinal (GI) bleeding in patients with continuous flow left ventricular assist device (cf-LVAD). In a single centre, 90 patients (mean age 52.0 ± 10.5 years), of which 59 were male and 31 were female, had cf-LVAD implantation from October 2010 to November 2012. Seventy-six (84.4%) patients had HeartWare (Medtronic, Mounds View, MN) and 14 (15.5%) had Heartmate II (Thoratec, Pleasanton, CA) implanted. vWF level, ristocetin cofactor level, and platelet count were measured before and after implantation to determine the presence of acquired von Willebrand Syndrome; aortic valve movement and postoperative RHF were evaluated to compare the difference in bleeding and nonbleeding patient groups. Fifteen patients (16.6%) suffered GI bleeding after cf-LVAD implantation. A statistically significant decrease was found in vWF and ristocetin cofactor levels from preoperative period to postoperative period in both bleeding and nonbleeding patient groups (p < 0.05). There was no significant difference in bleeding and nonbleeding groups regarding aortic valve movements (p ≥ 0.05). Postoperative RHF incidence was significantly high in the bleeding patient group compared with the nonbleeding group (p < 0.05). Therefore, depending on the findings of this study, acquired von Willebrand Syndrome was seen in all cf-LVAD patients, and postoperative RHF was an important risk factor for GI bleeding.

From the *Department of Cardiovascular Surgery, Near East University Faculty of Medicine, Nicosia, Cyprus; Department of Cardiology, Near East University Faculty of Medicine, Nicosia, Cyprus; Department of Cardiovascular Surgery, Ege University Faculty of Medicine, Izmir, Turkey; §Department of Cardiovascular Surgery, Tepecik Education and Research Hospital, Izmir, Turkey; and Department of Cardiology, Ege University Faculty of Medicine, Izmir, Turkey.

Submitted for consideration December 2016; accepted for publication in revised form August 2017.

Presented at the 36th Annual Meeting and Scientific Sessions of ISHLT, April 27–30, 2016, Washington, DC.

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

Correspondence: Ozlem Balcioglu, Department of Cardiovascular Surgery, Near East University, Nicosia, Cyprus. Email:

Copyright © 2018 by the American Society for Artificial Internal Organs