Skip to main content

Advertisement

SpringerLink
Log in

Gastrointestinal bleeding in recipients of left ventricular assist devices—a systematic review

  • Published:
Heart Failure Reviews Aims and scope Submit manuscript

Abstract

The twenty-first century has revolutionized the management of congestive heart failure with the widespread use of left ventricular assist devices and other treatment modalities that improve morbidity and mortality after the failure of medical management. These novel devices come with significant side effects. One of the most common side effects of left ventricular assist devices is the increased frequency of lower gastrointestinal bleeding compared to heart failure patients without left ventricular assist devices. Multiple etiologies of recurrent gastrointestinal bleeding in such patients have been studied. The decreased amount of von Willebrand factor polymers is now recognized as one of the most common causes of increased incidence of gastrointestinal bleeding in patients with left ventricular assist devices alongside increased arteriovenous malformations. Multiple treatment modalities have been identified to prevent and treat gastrointestinal bleeding in these patients. Since the use of left ventricular assist devices is becoming more prevalent in patients with advanced heart failure, we decided to conduct this systematic review. The article summarizes the incidence, pathophysiology, and management of lower gastrointestinal bleeding in patients with left ventricular assist devices.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Availability of data and materials

All articles used in the review are indexed in databases.

References

  1. Centers for Medicare & Medicaid Services. [Accessed on: 25 Nov 2015];Chronic conditions overview. Available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Chronic-Conditions/CC_Main.html

  2. McMurray JJ, Petrie MC, Murdoch DR, Davie AP (1998) Clinical epidemiology of heart failure: public and private health burden. Eur Heart J 19(Suppl P):P9–P16

    PubMed  Google Scholar 

  3. Lloyd-Jones DM, Larson MG, Leip EP et al (2002) Lifetime risk for developing congestive heart failure: The Framingham Heart Study. Circulation 106(24):3068–3072

    Article  PubMed  Google Scholar 

  4. Lesyuk W, Kriza C, Kolominsky-Rabas P (2018) Cost-of-illness studies in heart failure: a systematic review 2004–2016. BMC Cardiovasc Disord 18(1):74. Published 2018 May 2. https://doi.org/10.1186/s12872-018-0815-3

  5. Virani SS, Alonso A, Benjamin EJ et al (2020) Heart disease and stroke statistics-2020 update: a report from the American Heart Association. Circulation 141(9):e139–e596. https://doi.org/10.1161/CIR.0000000000000757

    Article  PubMed  Google Scholar 

  6. Owan TE, Redfield MM (2005) Epidemiology of diastolic heart failure. Prog Cardiovasc Dis 47(5):320–332. https://doi.org/10.1016/j.pcad.2005.02.010

    Article  PubMed  Google Scholar 

  7. Marwick TH (1998) The viable myocardium: epidemiology, detection, and clinical implications. Lancet 351(9105):815–819. https://doi.org/10.1016/S0140-6736(97)08080-X

    Article  CAS  PubMed  Google Scholar 

  8. MacDonald D (1914) Chronic valvular disease of the heart: its etiology, the factors leading to failure of compensation, and the symptoms produced. Glasgow Med J 81(1):12–32

    PubMed  PubMed Central  Google Scholar 

  9. Brieler J, Breeden MA, Tucker J (2017) Cardiomyopathy: an overview. Am Fam Physician 96(10):640–646

    PubMed  Google Scholar 

  10. Messerli FH, Rimoldi SF, Bangalore S (2017) The transition from hypertension to heart failure: contemporary update [published correction appears in JACC Heart Fail. 2017 Dec;5(12 ):948]. JACC Heart Fail 5(8):543–551. https://doi.org/10.1016/j.jchf.2017.04.012

    Article  PubMed  Google Scholar 

  11. Page RL, O’Bryant CL, Cheng D et al (2016) Drugs that may cause or exacerbate heart failure: a scientific statement from the American Heart Association [published correction appears in Circulation. 2016 Sep 20;134(12):e261]. Circulation. 134(6):e32–e69. https://doi.org/10.1161/CIR.0000000000000426

    Article  CAS  PubMed  Google Scholar 

  12. Inamdar AA, Inamdar AC (2016) Heart failure: diagnosis, management and utilization. J Clin Med. 5(7):62. https://doi.org/10.3390/jcm5070062. PMID: 27367736; PMCID: PMC4961993

  13. Yancy CW, Jessup M, Bozkurt B et al (2013) ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 128(16):1810–1852. https://doi.org/10.1161/CIR.0b013e31829e8807

    Article  PubMed  Google Scholar 

  14. Kirklin JK, Naftel DC, Kormos RL et al (2012) The Fourth INTERMACS Annual Report: 4,000 implants and counting. J Heart Lung Transplant 31(2):117–126. https://doi.org/10.1016/j.healun.2011.12.001

    Article  PubMed  Google Scholar 

  15. Miller LW, Pagani FD, Russell SD et al (2007) Use of a continuous-flow device in patients awaiting heart transplantation. N Engl J Med 357(9):885–896. https://doi.org/10.1056/NEJMoa067758

    Article  CAS  PubMed  Google Scholar 

  16. Slaughter MS, Rogers JG, Milano CA et al (2009) Advanced heart failure treated with continuous-flow left ventricular assist device [published correction appears in N Engl J Med. 2018 Aug 16;379(7):697]. N Engl J Med 361(23):2241–2251. https://doi.org/10.1056/NEJMoa0909938

    Article  CAS  PubMed  Google Scholar 

  17. Levine A, Gass A (2019) Third-generation LVADs: Has anything changed? Cardiol Rev 27(6):293–301. https://doi.org/10.1097/CRD.0000000000000268

    Article  PubMed  Google Scholar 

  18. Potapov EV, Stepanenko A, Krabatsch T, Hetzer R (2011) Managing long-term complications of left ventricular assist device therapy. Curr Opin Cardiol 26(3):237–244. https://doi.org/10.1097/HCO.0b013e328345af80

    Article  PubMed  Google Scholar 

  19. Feldman D, Pamboukian SV, Teuteberg JJ et al (2013) The 2013 International Society for Heart and Lung Transplantation Guidelines for mechanical circulatory support: executive summary. J Heart Lung Transplant 32(2):157–187. https://doi.org/10.1016/j.healun.2012.09.013

    Article  PubMed  Google Scholar 

  20. Eckman PM, John R (2012) Bleeding and thrombosis in patients with continuous-flow ventricular assist devices. Circulation 125(24):3038–3047. https://doi.org/10.1161/CIRCULATIONAHA.111.040246

    Article  PubMed  Google Scholar 

  21. Berg D et al (2019) The predicament of gastrointestinal bleeding in patients with a continuous-flow left ventricular assist device: pathophysiology, evaluation, and management. Cardiol Rev 27(5):222–229

    Article  PubMed  Google Scholar 

  22. Guha A et al (2015) Gastrointestinal bleeding after continuous-flow left ventricular device implantation: review of pathophysiology and management. Methodist Debakey Cardiovasc J 11(1):24–27

    Article  PubMed  PubMed Central  Google Scholar 

  23. Islam S et al (2013) Left ventricular assist devices and gastrointestinal bleeding: a narrative review of case reports and case series. Clin Cardiol 36(4):190–200

    Article  PubMed  PubMed Central  Google Scholar 

  24. Mehta A et al (2015) Outcomes of patients with left ventricular assist devices undergoing mesenteric angiography for gastrointestinal bleeding. J Vasc Interv Radiol 26(11):1710–1717

    Article  PubMed  Google Scholar 

  25. Abbas A et al (2017) Gastrointestinal bleeding during the index hospitalization for mechanical circulatory support devices implantation, a nationwide perspective. Dig Dis Sci 62(1):161–174

    Article  PubMed  Google Scholar 

  26. Goldstein DJ et al (2015) Gastrointestinal bleeding in recipients of the HeartWare Ventricular Assist System. JACC Heart Fail 3(4):303–313

    Article  PubMed  Google Scholar 

  27. Singh, G., et al (2015) Features of patients with gastrointestinal bleeding after implantation of ventricular assist devices. Clin Gastroenterol Hepatol 13(1):107–114.e101

    Article  PubMed  Google Scholar 

  28. Aggarwal A et al (2012) Incidence and management of gastrointestinal bleeding with continuous flow assist devices. Ann Thorac Surg 93(5):1534–1540

    Article  PubMed  Google Scholar 

  29. Thohan V et al (2019) The association between novel clinical factors and gastrointestinal bleeding among patients supported with continuous-flow left ventricular assist device therapy. J Card Surg 34(6):453–462

    Article  PubMed  Google Scholar 

  30. Sakatsume K et al (2018) Association between the severity of acquired von Willebrand syndrome and gastrointestinal bleeding after continuous-flow left ventricular assist device implantation. Eur J Cardiothorac Surg 54(5):841–846

    Article  PubMed  Google Scholar 

  31. Uriel N et al (2010) Acquired von Willebrand syndrome after continuous-flow mechanical device support contributes to a high prevalence of bleeding during long-term support and at the time of transplantation. J Am Coll Cardiol 56(15):1207–1213

    Article  PubMed  Google Scholar 

  32. Bartoli CR et al (2018) Clinical and in vitro evidence that left ventricular assist device-induced Von Willebrand factor degradation alters angiogenesis. Circ Heart Fail 11(9):e004638

    Article  CAS  PubMed  Google Scholar 

  33. Oezpeker C et al (2018) Changes in Von Willebrand factor profile predicts clinical outcomes in patients on mechanical circulatory support. J Card Surg 33(10):693–702

    Article  PubMed  Google Scholar 

  34. Tomizawa Y et al (2018) Preoperative right-sided cardiac congestion is associated with gastrointestinal bleeding in patients with continuous-flow left ventricular assist devices. Dig Dis Sci 63(6):1518–1524

    Article  PubMed  Google Scholar 

  35. Edwards AL et al (2018) Association of pulsatility with gastrointestinal bleeding in a cohort of HeartMate II recipients. Asaio j 64(4):472–479

    Article  PubMed  Google Scholar 

  36. Demirozu ZT et al (2011) Arteriovenous malformation and gastrointestinal bleeding in patients with the HeartMate II left ventricular assist device. J Heart Lung Transplant 30(8):849–853

    PubMed  Google Scholar 

  37. Marsano J et al (2015) Characteristics of gastrointestinal bleeding after placement of continuous-flow left ventricular assist device: a case series. Dig Dis Sci 60(6):1859–1867

    Article  PubMed  Google Scholar 

  38. Axelrad JE et al (2018) Limited usefulness of endoscopic evaluation in patients with continuous-flow left ventricular assist devices and gastrointestinal bleeding. J Heart Lung Transplant 37(6):723–732

    Article  PubMed  Google Scholar 

  39. Converse, M. P., et al (2019) Effect of Angiotensin II inhibitors on gastrointestinal bleeding in patients with left ventricular assist devices. J Am Coll Cardiol 73(14):1769–1778

    Article  PubMed  Google Scholar 

  40. Houston BA et al (2017) Angiotensin II antagonism is associated with reduced risk for gastrointestinal bleeding caused by arteriovenous malformations in patients with left ventricular assist devices. J Heart Lung Transplant 36(4):380–385

    Article  PubMed  Google Scholar 

  41. Seng BJJ et al (2017) Novel use of low-dose thalidomide in refractory gastrointestinal bleeding in left ventricular assist device patients. Int J Artif Organs 40(11):636–640

    Article  PubMed  Google Scholar 

  42. Shah KB et al (2017) Multicenter evaluation of octreotide as secondary prophylaxis in patients with left ventricular assist devices and gastrointestinal bleeding. Circ Heart Fail 10(11)

  43. Imamura T et al (2018) Omega-3 therapy is associated with reduced gastrointestinal bleeding in patients with continuous-flow left ventricular assist device. Circ Heart Fail 11(10):e005082

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Schurr JW et al (2019) Long-term discontinuation of antithrombotic therapy in patients with HeartMate II continuous-flow left ventricular assist device support. Int J Artif Organs 42(12):770–774

    Article  PubMed  Google Scholar 

  45. Pollari F et al (2016) Anticoagulation with apixaban in a patient with a left ventricular assist device and gastrointestinal bleeding: a viable alternative to warfarin? J Thorac Cardiovasc Surg 151(4):e79–81

    Article  PubMed  Google Scholar 

  46. Hickman AW et al (2019) Acid suppression to prevent gastrointestinal bleeding in patients with ventricular assist devices. J Surg Res 234:96–102

    Article  PubMed  Google Scholar 

  47. Jabbar HR et al (2015) The incidence, predictors and outcomes of gastrointestinal bleeding in patients with left ventricular assist device (LVAD). Dig Dis Sci 60(12):3697–3706

    Article  PubMed  Google Scholar 

  48. Cleland JG, Puri S (1994) How do ACE inhibitors reduce mortality in patients with left ventricular dysfunction with and without heart failure: remodelling, resetting, or sudden death? Br Heart J 72(3 Suppl):S81–S86. https://doi.org/10.1136/hrt.72.3_suppl.s81

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Missouri, Kansas City, USA

    Ali Naveed & Talal Asif

  2. King Edward Medical University, Lahore, Pakistan

    Bazigh Naveed

  3. Medical Center, University of Kansas, Kansas City, USA

    Muhammad Atif Khan

Authors
  1. Ali Naveed
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bazigh Naveed
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Muhammad Atif Khan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Talal Asif
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Ali Naveed, MD: conceptualization, literature review, data extraction, write-up. Final review. Corresponding author. Bazigh Naveed, MD: literature review and data extraction, write up. Muhammad Atif Khan, MD, FACP: article review and editing. Talal Asif, MD, FACC: article review, editing, and conceptualization.

Corresponding author

Correspondence to Ali Naveed.

Ethics declarations

Ethical approval

All the data used in this systematic review is extracted from public information, and the review did not involve human subjects. So, IRB approval is not required.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Naveed, A., Naveed, B., Khan, M.A. et al. Gastrointestinal bleeding in recipients of left ventricular assist devices—a systematic review. Heart Fail Rev 28, 1163–1175 (2023). https://doi.org/10.1007/s10741-023-10313-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10741-023-10313-6

Keywords

Search

Navigation