Bleeding with the artificial heart: Gastrointestinal hemorrhage in CF-LVAD patients

• Published in: World journal of gastroenterology : WJG Vol. 23; no. 22; pp. 3945 - 3953
• Main Authors: Gurvits, Grigoriy E, Fradkov, Elena
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Inc 14.06.2017
• Subjects: Angiodysplasia - etiology; Angiodysplasia - history; Angiodysplasia - mortality; Angiodysplasia - therapy; Animals; Anticoagulants - adverse effects; Blood Coagulation; Gastrointestinal Hemorrhage - etiology; Gastrointestinal Hemorrhage - history; Gastrointestinal Hemorrhage - mortality; Gastrointestinal Hemorrhage - therapy; Heart Failure - history; Heart Failure - mortality; Heart Failure - physiopathology; Heart Failure - therapy; Heart-Assist Devices - adverse effects; Heart-Assist Devices - history; History, 20th Century; History, 21st Century; Humans; Platelet Aggregation Inhibitors - adverse effects; Prosthesis Design; Recovery of Function; Risk Assessment; Risk Factors; Treatment Outcome; Ventricular Function, Left; Heart failure; Left ventricular assist devices; Endoscopy; Angioectasia; Gastrointestinal bleeding
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v23.i22.3945

Continuous-flow left ventricular assist devices(CF-LVADs)have significantly improved outcomes for patients with end-stage heart failure when used as a bridge to cardiac transplantation or,more recently,as destination therapy.However,its implantations carries a risk of complications including infection,device malfunction,arrhythmias,right ventricular failure,thromboembolic disease,postoperative and nonsurgical bleeding.A significant number of left ventricular assist devices(LVAD)recipients may experience recurrent gastrointestinal hemorrhage,mainly due to combination of antiplatelet and vitamin K antagonist therapy,activation of fibrinolytic pathway,acquired von Willebrand factor deficiency,and tendency to develop small intestinal angiodysplasias due to increased rotary speed of the pump.Gastrointestinal bleeding in LVAD patients remains a source of increased morbidity including the need for blood transfusions,extended hospital stays,multiple readmissions,and overall mortality.Management of gastrointestinal bleeding in LVAD patients involves multidisciplinary approach in stabilizing the patients,addressing risk factors and performing structured endoluminal evaluation with focus on upper gastrointestinal tract including jejunum to find and eradicate culprit lesion.Medical and procedural intervention is largely successful and universal bleeding cessation occurs in transplanted patients.