Gastrointestinal Symptoms from Left Ventricular Assist Device External Compression of the Gastric Lumen

Abstract

Left ventricular assist device (LVAD) implantation is an increasingly prevalent form of mechanical circulatory support as a bridge to heart transplant and as destination therapy. While bleeding remains the most recognized gastrointestinal (GI) adverse event, there have been reports on other complications due to GI tract luminal compression from the device. A 74-year-old man with end-stage ischemic cardiomyopathy underwent LVAD implantation with a Heartmate IITM (Thoratec, Pleasanton, CA, USA) as destination therapy, three years prior to his hospital admission for melena (Figure 1). On review of symptoms, the patient had been endorsing early satiety, intermittent nausea and non-specific abdominal discomfort since LVAD implantation. Esophagogastroduodenoscopy (EGD) and colonoscopy prior to LVAD placement had been unremarkable. EGD revealed moderate external compression of the anterior gastric wall from the LVAD pump and outflow tract with luminal narrowing in the antrum (Figure 2). This was associated with some mild resistance to the maneuvering of the endoscope across the pylorus and into the duodenum. A bleeding angioectasia was found in the second portion of the duodenum and treated. The patient recovered without further episodes of GI bleeding and hemoglobin remained stable.Figure 1Figure 2Figure 3Apart from its increased association with bleeding, the effects of LVAD implantation on the GI system have not been clearly defined. In this case, we speculate that the patient's symptoms of early satiety and nausea coincided with LVAD implantation in the setting of endoscopic evidence of gastric luminal compression and distortion from the device. Overall, while bleeding may be the most commonly encountered GI manifestation in LVAD patients, other potential complications, including luminal compression from the device, should be recognized given the increasing use of these devices.