Gastrointestinal Bleeding during Continuous-Flow Left Ventricular Assist Device Support is Associated with Lower Rates of Cardiac Transplantation

Gastrointestinal bleeding (GIB) remains a significant problem after continuous-flow left ventricular assist device (CF-LVAD) implantation. We hypothesized that the subsequent need for blood transfusions in patients with GIB may reduce rates of cardiac transplantation. We performed a retrospective re...

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Bibliographic Details
Published inASAIO journal (1992) Vol. 61; no. 6; p. 635
Main Authors Holley, Christopher T, Harvey, Laura, Roy, Samit S, Cogswell, Rebecca, Eckman, Peter, Liao, Kenneth, John, Ranjit
Format Journal Article
LanguageEnglish
Published United States 01.11.2015
Subjects
Adult
Aged
Anticoagulants - adverse effects
Female
Gastrointestinal Hemorrhage - etiology
Gastrointestinal Hemorrhage - therapy
Heart Failure - surgery
Heart Transplantation
Heart-Assist Devices - adverse effects
Hematologic Agents - adverse effects
Histocompatibility
Humans
Male
Middle Aged
Platelet Aggregation Inhibitors - adverse effects
Retrospective Studies
Risk Factors
Transfusion Reaction
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Summary:Gastrointestinal bleeding (GIB) remains a significant problem after continuous-flow left ventricular assist device (CF-LVAD) implantation. We hypothesized that the subsequent need for blood transfusions in patients with GIB may reduce rates of cardiac transplantation. We performed a retrospective review of 232 patients implanted with the HeartMate II (HM II) CF-LVAD from June 2005 through May 2013 at our center to determine risk factors for GIB and assess its effect on cardiac transplantation. Over a total LVAD follow-up time of 364 person-years, 62 GIB episodes occurred in 49 patients (27%), for an event rate of 0.45 gastrointestinal bleeds/patient-year of LVAD support. Women made up 15% of our cohort, yet contributed 29% of the GIB (p = 0.06). Survival at 6 month, 1 year, and 2 years was not statistically different in patients who developed GIB and those who did not (77% vs 78%, 74% vs 71%, and 61% vs 54%, respectively). In transplant-eligible patients, GIB was associated with a 27% lower rate of cardiac transplantation (rate ratio 0.73, p < 0.05). Although the mechanism behind this finding is unclear, GIB appears to be linked to higher transfusion rates, which may cause the development of subsequent allosensitization.
ISSN:1538-943X
DOI:10.1097/MAT.0000000000000279