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Preoperative Right-Sided Cardiac Congestion Is Associated with Gastrointestinal Bleeding in Patients with Continuous-Flow Left Ventricular Assist Devices

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Abstract

Background

Large scale data on preoperative risk stratification for gastrointestinal bleeding (GIB) following continuous-flow left ventricular assist device (CF-LVAD) implantation are scarce.

Aims

To identify independent predictors for GIB following CF-LVAD implantation.

Methods

We conducted a retrospective cohort study of consecutive 243 patients who underwent CF-LVAD implantation (HeartMateII) from January 2009 to March 2015 at the University of Chicago Medical Center. GIB was defined as the presence of overt bleeding or occult GIB with ≥ 2 g/dl drop in hemoglobin (Hgb) from recorded baseline values and hemoccult-positive stool. The preoperative and postoperative data were reviewed.

Results

Within a median follow-up duration of 408 (IQR 113–954) days, 83 (34%) patients developed GIB after a median of 149 (IQR 27–615) days after implantation of CF-LVAD. There were no significant differences between the groups of GIB and non-GIB with respect to preoperative demographics and comorbidity except for ethnicity. The source of bleeding was identified in 39 (47%) patients and arteriovenous malformation or submucosal streaming vessel was the most frequent cause of bleeding (18/39, 46%). Multivariate-adjusted analysis demonstrated preoperative central venous pressure (CVP) ≥ 18 mmHg (HR 3.56; 95% CI 1.16–10.9; p = 0.026), mean pulmonary artery pressure (mPA) ≥ 36 mmHg (HR 4.14; 95% CI 1.35–12.7; p = 0.013), and the presence of moderate/severe tricuspid valve disease (HR 1.01; 95% CI 1.01–3.86; p = 0.046) were associated with the risk of GIB.

Conclusions

In this study, preoperative right-sided cardiac congestion (i.e., increased CVP, mPA and the presence of moderate/severe tricuspid valve disease) was associated with GIB in patients with CF-LVAD.

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References

  1. Kushnir VM, Sharma S, Ewald GA, et al. Evaluation of GI bleeding after implantation of left ventricular assist device. Gastrointest Endosc. 2012;75:973–979.

    Article  PubMed  Google Scholar 

  2. Shrode CW, Draper KV, Huang RJ, et al. Significantly higher rates of gastrointestinal bleeding and thromboembolic events with left ventricular assist devices. Clin Gastroenterol Hepatol. 2014;12:1461–1467.

    Article  PubMed  Google Scholar 

  3. Marsano J, Desai J, Chang S, Chau M, Pochapin M, Gurvits GE. Characteristics of gastrointestinal bleeding after placement of continuous-flow left ventricular assist device: a case series. Dig Dis Sci. 2015;60:1859–1867. https://doi.org/10.1007/s10620-015-3538-7.

    Article  PubMed  Google Scholar 

  4. Jabbar HR, Abbas A, Ahmed M, et al. The incidence, predictors and outcomes of gastrointestinal bleeding in patients with left ventricular assist device (LVAD). Dig Dis Sci. 2015;60:3697–3706. https://doi.org/10.1007/s10620-015-3743-4.

    Article  PubMed  Google Scholar 

  5. Draper KV, Huang RJ, Gerson LB. GI bleeding in patients with continuous-flow left ventricular assist devices: a systematic review and meta-analysis. Gastrointest Endosc. 2014;80:435–446.

    Article  PubMed  Google Scholar 

  6. Morgan JA, Paone G, Nemeh HW, et al. Gastrointestinal bleeding with the HeartMate II left ventricular assist device. J Heart Lung Transplant. 2012;31:715–718.

    Article  PubMed  Google Scholar 

  7. Stulak JM, Lee D, Haft JW, et al. Gastrointestinal bleeding and subsequent risk of thromboembolic events during support with a left ventricular assist device. J Heart Lung Transplant. 2014;33:60–64.

    Article  PubMed  Google Scholar 

  8. Sparrow CT, Nassif ME, Raymer DS, et al. Pre-operative right ventricular dysfunction is associated with gastrointestinal bleeding in patients supported with continuous-flow left ventricular assist devices. JACC Heart Fail. 2015;3:956–964.

    Article  PubMed  Google Scholar 

  9. Newby LK, Bhapkar MV, White HD, et al. SYMPHONY and 2nd SYMPHONY Investigators. Aspirin use post-acute coronary syndromes: intolerance, bleeding and discontinuation. J Thromb Thrombolysis. 2003;16:119–128.

    Article  PubMed  CAS  Google Scholar 

  10. Nikolsky E, Stone GW, Kirtane AJ, et al. Gastrointestinal bleeding in patients with acute coronary syndromes: incidence, predictors, and clinical implications: analysis from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial. J Am Coll Cardiol. 2009;54:1293–1302.

    Article  PubMed  CAS  Google Scholar 

  11. Moukarbel GV, Signorovitch JE, Pfeffer MA, et al. Gastrointestinal bleeding in high risk survivors of myocardial infarction: the VALIANT Trial. Eur Heart J. 2009;30:2226–2232.

    Article  PubMed  Google Scholar 

  12. Guha A, Eshelbrenner CL, Richards DM, et al. Gastrointestinal bleeding after continuous-flow left ventricular device implantation: review of pathophysiology and management. Methodist Debakey Cardiovasc J. 2015;11:24–27.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Demirozu ZT, Radovancevic R, Hochman LF, et al. Arteriovenous malformation and gastrointestinal bleeding in patients with the HeartMate II left ventricular assist device. J Heart Lung Transplant. 2011;30:849–853.

    Article  PubMed  Google Scholar 

  14. Letsou GV, Shah N, Gregoric ID, et al. Gastrointestinal bleeding from arteriovenous malformations in patients supported by the Jarvik 2000 axial-flow left ventricular assist device. J Heart Lung Transplant. 2005;24:105–109.

    Article  PubMed  Google Scholar 

  15. Hetzer R, Weng Y, Potapov EV, et al. First experiences with a novel magnetically suspended axial flow left ventricular assist device. Eur J Cardiothorac Surg. 2004;25:964–970.

    Article  PubMed  Google Scholar 

  16. Crow S, John R, Boyle A, et al. Gastrointestinal bleeding rates in recipients of nonpulsatile and pulsatile left ventricular assist devices. J Thoracic Cardiovasc Surg. 2009;137:208–215.

    Article  CAS  Google Scholar 

  17. Cappell MS, Lebwohl O. Cessation of recurrent bleeding from gastrointestinal angiodysplasias after aortic valve replacement. Ann Intern Med. 1986;105:55–57.

    Article  Google Scholar 

  18. Saito S, Westaby S, Piggot D, et al. Endorgan function during chronic nonpulsatile circulation. Ann Thorac Surg. 2002;74:1080–1085.

    Article  PubMed  Google Scholar 

  19. Vincentelli A, Susen S, Le Tourneau T, et al. Acquired von Willebrand syndrome in aortic stenosis. N Engl J Med. 2003;349:343–349.

    Article  PubMed  Google Scholar 

  20. Boley SJ, Sammartano RJ, Adams A, et al. On the nature and etiology of vascular ectasia of the colon. Gastroenterology. 1977;72:650–660.

    PubMed  CAS  Google Scholar 

  21. Holleran G, Hall B, Hussey M, et al. Small bowel angiodysplasia and novel disease associations: a cohort study. Small bowel angiodysplasia and novel disease associations: a cohort study. Scand J Gastroenterol. 2013;48:433–438.

    Article  PubMed  Google Scholar 

  22. Sidhu PS, McAlindon ME, Drew K, et al. Hematological disease a further association with small bowel angioectasia? Scand J Gastroenterol. 2013;48:1102.

    Article  PubMed  Google Scholar 

  23. Patel SR, Madan S, Saeed O, et al. Association of nasal mucosal vascular alterations, gastrointestinal arteriovenous malformations, and bleeding in patients with continuous-flow left ventricular assist devices. JACC Heart Fail. 2016;4:962–970.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago Medicine, Chicago, USA

    Yutaka Tomizawa & Atsushi Sakuraba

  2. Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, USA

    Akiko Tanaka & Nir Uriel

  3. Section of Cardiac and Thoracic Surgery, Department of Surgery, University of Chicago Medicine, 5841 S. Maryland Ave., MC 5040, Chicago, IL, 60637, USA

    Hiroto Kitahara, Valluvan Jeevanandam & Takeyoshi Ota

Authors
  1. Yutaka Tomizawa
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  2. Akiko Tanaka
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  3. Hiroto Kitahara
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  4. Atsushi Sakuraba
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  5. Nir Uriel
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  6. Valluvan Jeevanandam
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  7. Takeyoshi Ota
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Correspondence to Takeyoshi Ota.

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Tomizawa, Y., Tanaka, A., Kitahara, H. et al. Preoperative Right-Sided Cardiac Congestion Is Associated with Gastrointestinal Bleeding in Patients with Continuous-Flow Left Ventricular Assist Devices. Dig Dis Sci 63, 1518–1524 (2018). https://doi.org/10.1007/s10620-018-4916-8

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  • DOI: https://doi.org/10.1007/s10620-018-4916-8

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