Gastrointestinal Bleeding Was Rare with Centrifugal Type Continuous Flow Left Ventricular Assist Device EVAHEART

Abstract

Purpose Gastrointestinal (GI) bleeding is crucial issue in long-term management of continuous-flow (CF) left ventricular assist device (LVAD) patients, and it has been reported that lack of high-molecular-weight (HMW) von Willebrand factor (vWF) multimers is supposed to be one of the causes of GI bleeding. Aim of this study was to investigate a relationship between the prevalence of GI bleeding in our centrifugal type CF-LVAD and the effects on vWF. Methods and Materials An implantable centrifugal blood pump (EVAHEART, SunMedical Technology Research Co., Japan) has a very flat HQ curve to generate pulsed high systemic flow circulatory support. We performed EVAHEART implantation for 11 patients with advanced heart failure (INTERMACS profile I-III, eligible for heart transplantation, mean age 37). Coumadin sodium (PT-INR 2.5-3.0) and Aspirin (100-300mg) were given for anticoagulation therapy. Laboratory data of blood coagulation system, vWF antigen, and vWF ristocetin cofactor (Rco) activity were measured pre and post-operatively, while vWF multimer status was also analyzed. Results All patients survived, while 2 of them underwent heart transplantation. There was no active GI bleeding in all patients. The measurement of laboratory data were shown in Figure 1 .The patients had no signs of hemolytic anemia after implantation. The vWF multimers were well maintained in all patients. The values of vWF antigen and vWF Rco activity decreased gradually, but were kept within normal ranges (figure1 graph). Conclusions Centrifugal type CF-LVAD EVAHEART provided low incidence of GI bleeding with slight influences on the vWF.