title: Gastrointestinal bleeding rates in recipients of nonpulsatile and pulsatile left ventricular assist devices.
abstract: OBJECTIVE
  Pulsatile and nonpulsatile left ventricular assist devices are effective in managing congestive heart failure. Despite early evidence for clinical efficacy, the long-term impact of nonpulsatile flow on end-organ function remains to be determined. Our goal was to compare rates of gastrointestinal bleeding in nonpulsatile and pulsatile device recipients.
  
  
  METHODS
  In a retrospective review of 101 left ventricular assist device recipients (55 nonpulsatile, 46 pulsatile) from October 31, 2003, to June 1, 2007, at a single center, gastrointestinal bleeding was defined as guaiac-positive stool with hemoglobin drop requiring transfusion of at least 2 units of packed red blood cells. To assess bleeding risk outside the initial postoperative course, any patients with a device in place for 15 days or less was excluded.
  
  
  RESULTS
  Twelve nonpulsatile and 3 pulsatile left ventricular assist device recipients had gastrointestinal bleeding 16 days or longer after device implantation. The event rates were 63 events/100 patient-years for nonpulsatile devices and 6.8 events/100 patient-years for pulsatile devices (P = .0004). This difference persisted for bleeding occurring 31 days or longer after device implantation, with 46.5 events/100 patient-years for nonpulsatile devices versus 4.7 events/100 patient-years for pulsatile devices (P = .0028). Mortalities were similar between groups (15% nonpulsatile vs 17% pulsatile, P = .6965).
  
  
  CONCLUSIONS
  Patients with nonpulsatile left ventricular assist devices appear to have a higher rate of gastrointestinal bleeding events than do pulsatile left ventricular assist device recipients. Further prospective evaluation is needed to determine potential etiologies and strategies for reducing gastrointestinal bleeding in this population.
authors.affiliation: Division of Pediatric Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, USA. crow.sheri@mayo.edu
authors.forename: Sheri
authors.initials: S
authors.lastname: Crow
authors.forename: Ranjit
authors.initials: R
authors.lastname: John
authors.forename: Andrew
authors.initials: A
authors.lastname: Boyle
authors.forename: Sara
authors.initials: S
authors.lastname: Shumway
authors.forename: Kenneth
authors.initials: K
authors.lastname: Liao
authors.forename: Monica
authors.initials: M
authors.lastname: Colvin-Adams
authors.forename: Carol
authors.initials: C
authors.lastname: Toninato
authors.forename: Emil
authors.initials: E
authors.lastname: Missov
authors.forename: Marc
authors.initials: M
authors.lastname: Pritzker
authors.forename: Cindy
authors.initials: C
authors.lastname: Martin
authors.forename: Daniel
authors.initials: D
authors.lastname: Garry
authors.forename: William
authors.initials: W
authors.lastname: Thomas
authors.forename: Lyle
authors.initials: L
authors.lastname: Joyce
mesh_terms: D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology* / Q000209:etiology*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies