title: Gastrointestinal Bleeding during Continuous-Flow Left Ventricular Assist Device Support is Associated with Lower Rates of Cardiac Transplantation.
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.
authors.affiliation: From the *Department of Surgery, University of Minnesota, Minneapolis, Minnesota; and †Department of Cardiology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Holley
authors.forename: Laura
authors.initials: L
authors.lastname: Harvey
authors.forename: Samit S
authors.initials: SS
authors.lastname: Roy
authors.forename: Rebecca
authors.initials: R
authors.lastname: Cogswell
authors.forename: Peter
authors.initials: P
authors.lastname: Eckman
authors.forename: Kenneth
authors.initials: K
authors.lastname: Liao
authors.forename: Ranjit
authors.initials: R
authors.lastname: John
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006333:Heart Failure / Q000601:surgery; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000009:adverse effects; D006401:Hematologic Agents / Q000009:adverse effects*; D006648:Histocompatibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D065227:Transfusion Reaction
chemical_list: D000925:Anticoagulants; D006401:Hematologic Agents; D010975:Platelet Aggregation Inhibitors