Gastrointestinal bleeding with left ventricular assist devices (LVAD): Locating the leak and identifying outcomes

Sarah Malik, Shahbaz A. Malik, Laura L. Ulmer, Lokesh K. Jha, Michael S. Strupp, Eugenia Raichlin, Elizabeth R. Lyden, Alexander T. Hewlett

Research output: Contribution to journalArticle

Abstract

Background and Goals: Gastrointestinal bleeding (GIB) is a significant complication following left ventricular assist device (LVAD) implantation. We evaluated the incidence, predictors, endoscopic findings, and outcomes of GIB in LVAD recipients. Study: Retrospective review of 205 adult patients undergoing HeartMate II LVAD implantation from January 2012 to June 2016. Patients were reviewed and separated into GIB (n=57; 28%) and non-GIB (n=148; 72%) groups. Results: Median time to GIB was 55 (range, 3 to 730) days. The GIB group patients were older (61±12 vs. 56±13, P=0.0042), more often underwent concomitant tricuspid valve (TV) repair (16% vs. 4%, P=0.007), and a higher percentage were assigned for destination therapy (75% vs. 55%, P=0.01). Angioectasia (33%) was the most common identified cause of GIB. Median time to endoscopic intervention was 1 day. The total number of hospital readmissions after LVAD was higher in the GIB group (median of 5 vs. 3, P=0.001), as was the total number of blood products transfused after LVAD (29 vs. 13, P≤ 0.0001). GIB was associated with an increased risk of death (hazard ratio, 1.94; 95% confidence interval, 1.16-3.25; P= 0.01) and the mortality rate during hospitalization for GIB was 11% (P=0.0004). Receiving a heart transplant was associated with a decreased hazard of death (hazard ratio, 0.40; 95% confidence interval, 0.19-0.85; P=0.016). Conclusions: Older age and destination therapy as implant strategy were found to be associated with an increased risk of GIB, consistent with previous studies. A unique finding in our study is the association of TV repair with a higher incidence of GIB. Further studies are needed to investigate possible mechanisms by which TV repair increases the incidence of GIB.

Original languageEnglish (US)
Pages (from-to)E202-E207
JournalJournal of Clinical Gastroenterology
Volume53
Issue number5
DOIs
StatePublished - May 1 2019

Fingerprint

Heart-Assist Devices
Hemorrhage
Tricuspid Valve
Incidence
Confidence Intervals
Patient Readmission
Hospitalization

Keywords

  • Gastrointestinal bleeding
  • Left ventricular assist device
  • Outcome research

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Gastrointestinal bleeding with left ventricular assist devices (LVAD) : Locating the leak and identifying outcomes. / Malik, Sarah; Malik, Shahbaz A.; Ulmer, Laura L.; Jha, Lokesh K.; Strupp, Michael S.; Raichlin, Eugenia; Lyden, Elizabeth R.; Hewlett, Alexander T.

In: Journal of Clinical Gastroenterology, Vol. 53, No. 5, 01.05.2019, p. E202-E207.

Research output: Contribution to journalArticle

Malik, Sarah ; Malik, Shahbaz A. ; Ulmer, Laura L. ; Jha, Lokesh K. ; Strupp, Michael S. ; Raichlin, Eugenia ; Lyden, Elizabeth R. ; Hewlett, Alexander T. / Gastrointestinal bleeding with left ventricular assist devices (LVAD) : Locating the leak and identifying outcomes. In: Journal of Clinical Gastroenterology. 2019 ; Vol. 53, No. 5. pp. E202-E207.
@article{22f7c13970d14bd9b3f12219fd5c8c04,
title = "Gastrointestinal bleeding with left ventricular assist devices (LVAD): Locating the leak and identifying outcomes",
abstract = "Background and Goals: Gastrointestinal bleeding (GIB) is a significant complication following left ventricular assist device (LVAD) implantation. We evaluated the incidence, predictors, endoscopic findings, and outcomes of GIB in LVAD recipients. Study: Retrospective review of 205 adult patients undergoing HeartMate II LVAD implantation from January 2012 to June 2016. Patients were reviewed and separated into GIB (n=57; 28{\%}) and non-GIB (n=148; 72{\%}) groups. Results: Median time to GIB was 55 (range, 3 to 730) days. The GIB group patients were older (61±12 vs. 56±13, P=0.0042), more often underwent concomitant tricuspid valve (TV) repair (16{\%} vs. 4{\%}, P=0.007), and a higher percentage were assigned for destination therapy (75{\%} vs. 55{\%}, P=0.01). Angioectasia (33{\%}) was the most common identified cause of GIB. Median time to endoscopic intervention was 1 day. The total number of hospital readmissions after LVAD was higher in the GIB group (median of 5 vs. 3, P=0.001), as was the total number of blood products transfused after LVAD (29 vs. 13, P≤ 0.0001). GIB was associated with an increased risk of death (hazard ratio, 1.94; 95{\%} confidence interval, 1.16-3.25; P= 0.01) and the mortality rate during hospitalization for GIB was 11{\%} (P=0.0004). Receiving a heart transplant was associated with a decreased hazard of death (hazard ratio, 0.40; 95{\%} confidence interval, 0.19-0.85; P=0.016). Conclusions: Older age and destination therapy as implant strategy were found to be associated with an increased risk of GIB, consistent with previous studies. A unique finding in our study is the association of TV repair with a higher incidence of GIB. Further studies are needed to investigate possible mechanisms by which TV repair increases the incidence of GIB.",
keywords = "Gastrointestinal bleeding, Left ventricular assist device, Outcome research",
author = "Sarah Malik and Malik, {Shahbaz A.} and Ulmer, {Laura L.} and Jha, {Lokesh K.} and Strupp, {Michael S.} and Eugenia Raichlin and Lyden, {Elizabeth R.} and Hewlett, {Alexander T.}",
year = "2019",
month = "5",
day = "1",
doi = "10.1097/MCG.0000000000001041",
language = "English (US)",
volume = "53",
pages = "E202--E207",
journal = "Journal of Clinical Gastroenterology",
issn = "0192-0790",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Gastrointestinal bleeding with left ventricular assist devices (LVAD)

T2 - Locating the leak and identifying outcomes

AU - Malik, Sarah

AU - Malik, Shahbaz A.

AU - Ulmer, Laura L.

AU - Jha, Lokesh K.

AU - Strupp, Michael S.

AU - Raichlin, Eugenia

AU - Lyden, Elizabeth R.

AU - Hewlett, Alexander T.

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Background and Goals: Gastrointestinal bleeding (GIB) is a significant complication following left ventricular assist device (LVAD) implantation. We evaluated the incidence, predictors, endoscopic findings, and outcomes of GIB in LVAD recipients. Study: Retrospective review of 205 adult patients undergoing HeartMate II LVAD implantation from January 2012 to June 2016. Patients were reviewed and separated into GIB (n=57; 28%) and non-GIB (n=148; 72%) groups. Results: Median time to GIB was 55 (range, 3 to 730) days. The GIB group patients were older (61±12 vs. 56±13, P=0.0042), more often underwent concomitant tricuspid valve (TV) repair (16% vs. 4%, P=0.007), and a higher percentage were assigned for destination therapy (75% vs. 55%, P=0.01). Angioectasia (33%) was the most common identified cause of GIB. Median time to endoscopic intervention was 1 day. The total number of hospital readmissions after LVAD was higher in the GIB group (median of 5 vs. 3, P=0.001), as was the total number of blood products transfused after LVAD (29 vs. 13, P≤ 0.0001). GIB was associated with an increased risk of death (hazard ratio, 1.94; 95% confidence interval, 1.16-3.25; P= 0.01) and the mortality rate during hospitalization for GIB was 11% (P=0.0004). Receiving a heart transplant was associated with a decreased hazard of death (hazard ratio, 0.40; 95% confidence interval, 0.19-0.85; P=0.016). Conclusions: Older age and destination therapy as implant strategy were found to be associated with an increased risk of GIB, consistent with previous studies. A unique finding in our study is the association of TV repair with a higher incidence of GIB. Further studies are needed to investigate possible mechanisms by which TV repair increases the incidence of GIB.

AB - Background and Goals: Gastrointestinal bleeding (GIB) is a significant complication following left ventricular assist device (LVAD) implantation. We evaluated the incidence, predictors, endoscopic findings, and outcomes of GIB in LVAD recipients. Study: Retrospective review of 205 adult patients undergoing HeartMate II LVAD implantation from January 2012 to June 2016. Patients were reviewed and separated into GIB (n=57; 28%) and non-GIB (n=148; 72%) groups. Results: Median time to GIB was 55 (range, 3 to 730) days. The GIB group patients were older (61±12 vs. 56±13, P=0.0042), more often underwent concomitant tricuspid valve (TV) repair (16% vs. 4%, P=0.007), and a higher percentage were assigned for destination therapy (75% vs. 55%, P=0.01). Angioectasia (33%) was the most common identified cause of GIB. Median time to endoscopic intervention was 1 day. The total number of hospital readmissions after LVAD was higher in the GIB group (median of 5 vs. 3, P=0.001), as was the total number of blood products transfused after LVAD (29 vs. 13, P≤ 0.0001). GIB was associated with an increased risk of death (hazard ratio, 1.94; 95% confidence interval, 1.16-3.25; P= 0.01) and the mortality rate during hospitalization for GIB was 11% (P=0.0004). Receiving a heart transplant was associated with a decreased hazard of death (hazard ratio, 0.40; 95% confidence interval, 0.19-0.85; P=0.016). Conclusions: Older age and destination therapy as implant strategy were found to be associated with an increased risk of GIB, consistent with previous studies. A unique finding in our study is the association of TV repair with a higher incidence of GIB. Further studies are needed to investigate possible mechanisms by which TV repair increases the incidence of GIB.

KW - Gastrointestinal bleeding

KW - Left ventricular assist device

KW - Outcome research

UR - http://www.scopus.com/inward/record.url?scp=85064404531&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85064404531&partnerID=8YFLogxK

U2 - 10.1097/MCG.0000000000001041

DO - 10.1097/MCG.0000000000001041

M3 - Article

C2 - 29688916

AN - SCOPUS:85064404531

VL - 53

SP - E202-E207

JO - Journal of Clinical Gastroenterology

JF - Journal of Clinical Gastroenterology

SN - 0192-0790

IS - 5

ER -