title: Arteriovenous malformation and gastrointestinal bleeding in patients with the HeartMate II left ventricular assist device.
abstract: BACKGROUND
  In this study we investigated gastrointestinal (GI) bleeding and its relationship to arteriovenous malformations (AVMs) in patients with the continuous-flow HeartMate II (HMII) left ventricular assist device (LVAD).
  
  
  METHODS
  The records of 172 patients who received HMII support between November 2003 and June 2010 were reviewed. Patients were considered to have GI bleeding if they had 1 or more of the following symptoms: guaiac-positive stool; hematemesis; melena; active bleeding at the time of endoscopy or colonoscopy; and blood within the stomach at endoscopy or colonoscopy. The symptom(s) had to be accompanied by a decrease of >1 g/dl in the patient's hemoglobin level. The location of the bleeding was identified as upper GI tract, lower GI tract or both according to esophagogastroduodenoscopy, colonoscopy, small-bowel enteroscopy or mesenteric angiography. Post-LVAD implantation anti-coagulation therapy consisted of warfarin, aspirin and dipyridamole.
  
  
  RESULTS
  Thirty-two of the 172 patients (19%) had GI bleeding after 63 ± 62 (range 8 to 241) days of HMII support. Ten patients had GI bleeding from an AVM; these included 3 patients who had 2 bleeding episodes and 2 patients who had 5 episodes each. Sixteen patients had upper GI bleeding (10 hemorrhagic gastritis, 4 gastric AVM, 2 Mallory-Weiss syndrome), 15 had lower GI bleeding (6 diverticulosis, 6 jejunal AVM, 1 drive-line erosion of the colon, 1 sigmoid polyp, 1 ischemic colitis) and 1 had upper and lower GI bleeding (1 colocutaneous and gastrocutaneous fistula). All GI bleeding episodes were successfully managed medically.
  
  
  CONCLUSIONS
  Arteriovenous malformations can cause GI bleeding in patients with continuous-flow LVADs. In all cases in this series, GI bleeding was successfully managed without the need for surgical intervention.
authors.affiliation: Department of Cardiopulmonary Transplantation, Texas Heart Institute at St Luke's Episcopal Hospital, Houston, Texas 77225-0345, USA.
authors.forename: Zumrut T
authors.initials: ZT
authors.lastname: Demirozu
authors.forename: Rajko
authors.initials: R
authors.lastname: Radovancevic
authors.forename: Lyone F
authors.initials: LF
authors.lastname: Hochman
authors.forename: Igor D
authors.initials: ID
authors.lastname: Gregoric
authors.forename: George V
authors.initials: GV
authors.lastname: Letsou
authors.forename: Biswajit
authors.initials: B
authors.lastname: Kar
authors.forename: Roberta C
authors.initials: RC
authors.lastname: Bogaev
authors.forename: O H
authors.initials: OH
authors.lastname: Frazier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D001165:Arteriovenous Malformations / Q000150:complications* / Q000453:epidemiology*; D017707:Erythrocyte Transfusion; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D010949:Plasma; D015995:Prevalence; D012189:Retrospective Studies; D013923:Thromboembolism / Q000517:prevention & control; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000628:therapy*; D028761:Withholding Treatment; D055815:Young Adult
chemical_list: D000925:Anticoagulants