TY - JOUR
T1 - Gastrointestinal bleeding during continuous-flow left ventricular assist device support is associated with lower rates of cardiac transplantation
AU - Holley, Christopher T.
AU - Harvey, Laura
AU - Roy, Samit S.
AU - Cogswell, Rebecca
AU - Eckman, Peter
AU - Liao, Kenneth
AU - John, Ranjit
N1 - Publisher Copyright:
© 2015 by the American Society for Artificial Internal Organs.
PY - 2015/11/3
Y1 - 2015/11/3
N2 - 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.
AB - 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.
KW - Allosensitization
KW - Blood transfusion
KW - Cardiac transplantation
KW - Gastrointestinal bleeding
KW - Left ventricular assist device
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U2 - 10.1097/MAT.0000000000000279
DO - 10.1097/MAT.0000000000000279
M3 - Article
C2 - 26366686
AN - SCOPUS:84947017292
SN - 1058-2916
VL - 61
SP - 635
EP - 639
JO - ASAIO Journal
JF - ASAIO Journal
IS - 6
ER -