4:06 PM, Abstract No. 220 - Mesenteric angiography for GI bleeding in patients with left ventricular assist devices (LVAD): a single institution experience

Abstract

To follow outcomes of patients on anticoagulation with LVADs necessitating mesenteric angiography for GI bleeding compared with a control group. A retrospective study was conducted on 48 patients on anticoagulation presenting to our department with GI bleeding over a seven year period - 24 consecutive patients with LVAD (21 male, 3 female) and 24 consecutive control patients without LVAD (9 male, 15 female). Chi-square analysis for discrete variables (t-test for continuous variables) and multi-variate analysis were used for statistical evaluation. Mean ages were 62.1 ± 9.6 and 74.5 ± 11.3 years in LVAD and control patients, respectively. No statistically significant difference was observed in hemodynamic instability, hemoglobin or INR at presentation, or in hemoglobin nadir. Six embolizations were performed in LVAD patients; 2 had positive angiograms (8.3%) and the remainder underwent empiric embolization based on preprocedure localization. Of the 8 embolizations performed in control patients, all 8 had positive angiograms (33.3%) (p = 0.032). Clinical success with embolization was achieved in 2 of 6 LVAD patients (33.3%) and 7 of 8 control patients (87.5%) (p = 0.036). 7 LVAD patients (29.2%) and 1 control patient (4.5%) had repeat angiography within 14 days (p = 0.020). 7 LVAD patients (29.2%) and 4 control patients (18.2%) required post-procedural endoscopic or operative intervention for definitive therapy (p = 0.302). Average admission length was 28.4 days versus 12.6 days in control patients (p = 0.009). In-hospital mortality was 16.7% versus 4.2% (p = 0.032) and 1 year mortality was 33.3% versus 9.1% (p = 0.080) in LVAD and control patients, respectively. Patients with LVADs presenting with GI bleeding have lower rates of positive angiograms yielding fewer successful embolizations. There is a higher rate of clinical failure, with more frequent need for subsequent endoscopic or surgical intervention for definitive therapy. LVAD patients additionally suffer a greater in-hospital and 1-year mortality rate.