title: Gastrointestinal bleeding with the HeartMate II left ventricular assist device.
abstract: BACKGROUND
  Continuous flow left ventricular assist devices (CF-LVADs) have yielded improved outcomes compared with pulsatile flow devices for patients on long-term support. However, significant rates of gastrointestinal bleeding (GIB) have been observed during CF-LVAD support.
  
  
  METHODS
  From March 2006 through March 2011, 86 patients with chronic heart failure underwent implantation of a CF-LVAD (HeartMate II; Thoratec Corp., Pleasanton, CA). Records were reviewed to determine the prevalence of post-implant GIB, location of the bleeding site and associated morbidity and mortality. Uni- and multivariate analyses were conducted to identify independent predictors of GIB.
  
  
  RESULTS
  GIB occurred in 19 patients (22.1%) with a duration of support that ranged from 5 to 456 days. Sources of GIB included small bowel and rectum in 6 patients each, large bowel in 2 patients and stomach in 1 patient. No definite source was identified in 4 patients. There were no deaths referable to GIB. Recurrent GIB occurred in 4 patients. History of a GIB prior to LVAD implant was the only variable significantly different between patients with and without post-implant GIB (21.1% vs 10.4%, p = 0.016), and was the only independent predictor of GIB (OR = 2.24, 95% CI 2.121 to 2.435, p = 0.004).
  
  
  CONCLUSIONS
  Gastrointestinal bleeding is a frequent source of morbidity for patients on HeartMate II LVAD support but does not significantly impact survival. As implantation of CF-LVADs with non-pulsatile flow gains popularity for both bridge-to-transplant and destination therapy, a better understanding of the pathophysiology of GIB in these patients will be needed for minimizing this complication.
authors.affiliation: Division of Cardiothoracic Surgery, Heart and Vascular Institute, Henry Ford Hospital, Detroit, Michigan 48202, USA. jmorgan2@hfhs.org
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Morgan
authors.forename: Gaetano
authors.initials: G
authors.lastname: Paone
authors.forename: Hassan W
authors.initials: HW
authors.lastname: Nemeh
authors.forename: Scott E
authors.initials: SE
authors.lastname: Henry
authors.forename: Rosan
authors.initials: R
authors.lastname: Patel
authors.forename: Jessica
authors.initials: J
authors.lastname: Vavra
authors.forename: Celeste T
authors.initials: CT
authors.lastname: Williams
authors.forename: David E
authors.initials: DE
authors.lastname: Lanfear
authors.forename: Cristina
authors.initials: C
authors.lastname: Tita
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Brewer
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D006333:Heart Failure / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects* / Q000145:classification*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012008:Recurrence; D012189:Retrospective Studies
chemical_list: D000925:Anticoagulants