Gastrointestinal bleeding during continuous-flow left ventricular assist device support is associated with lower rates of cardiac transplantation

Christopher T. Holley, Laura Harvey, Samit S. Roy, Rebecca Cogswell, Peter Eckman, Kenneth Liao, Ranjit John

Research output: Contribution to journalArticlepeer-review

14 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)635-639
Number of pages5
JournalASAIO Journal
Volume61
Issue number6
DOIs
StatePublished - Nov 3 2015

Keywords

  • Allosensitization
  • Blood transfusion
  • Cardiac transplantation
  • Gastrointestinal bleeding
  • Left ventricular assist device

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