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The Predicament of Gastrointestinal Bleeding in Patients With a Continuous-Flow Left Ventricular Assist Device

Pathophysiology, Evaluation, and Management

Berg, Dana MD*; Lebovics, Edward MD; Kai, Masashi MD; Spielvogel, David MD

doi: 10.1097/CRD.0000000000000235
Review Articles

Heart failure affects over 5 million Americans, with numbers expected to rise. While heart transplantation is the most effective long-term strategy for end-stage heart failure, there is a limited cardiac donor pool, and these organs are often unavailable at the time of need. Left ventricular assist devices, therefore, continue to be used to bridge this gap. Originally implanted as a bridge to transplant, these devices are now additionally utilized as destination therapy for patients ineligible for transplant. With the widespread applicability of these devices for not just temporary measures, but also for prolonged use, the short- and long-term impact on other organ systems has become more evident. For example, gastrointestinal (GI) bleeding, with an incidence approaching 30%, is one such complication post–continuous-flow left ventricular assist device implantation. This high incidence of GI bleeding is thought to stem from a combination of factors, including the need for concomitant anticoagulant and antiplatelet therapy, and intrinsic device-related properties resulting in acquired Von Willebrand disease and arteriovenous malformations. Due to the significant morbidity associated with these GI bleeding events, a standardized protocol optimizing medical and endoscopic management, alongside close coordination between the gastroenterology and cardiology services, should be advocated for and ultimately employed.

From the *Department of Medicine, Division of Inflammatory Bowel Disease/Gastroenterology and Hepatology, NYU Langone Hospital, New York, NY

Department of Medicine, Division of Gastroenterology and Hepatobiliary Disease, New York Medical College/Westchester Medical Center, Valhalla, NY

Department of Surgery, Division of Cardiothoracic Surgery, New York Medical College/Westchester Medical Center, Valhalla, NY.

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

Correspondence: Dana Berg, MD, New York Medical College, 40 Sunshine Cottage Road, Skyline 2N-D04, Valhalla, NY 10595. E-mail:

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