Heart Failure Duration Association with Gastrointestinal Bleeding Post Left Ventricular Assist Device

Abstract

Gastrointestinal bleeding (GIB) is a frequent post left ventricular assist device (LVAD) co-morbidity with gastrointestinal angiodysplasia (GIAD) commonly implicated. Timing of LVAD therapy is variable, but no study has specifically analyzed duration of pre-LVAD heart failure on GI bleeding outcomes after VAD implantation. Between February 2007 and June 2019, 389 patients underwent primary LVAD implantation at our clinic. Median age at implant was 62 years (range, 18-82 years) and 306 (79%) were male. Etiology of heart failure was ischemic in 182 patients (47%) and indication for implant was destination therapy in 266 (69%). Axial flow pump was utilized in 282 (73%) and centrifugal flow in 105 (27%). Median preoperative duration of heart failure was 8.9 years. Early mortality occurred in 27/387 patients (7%). Follow-up was available in all 350 early survivors for a median of 1.8 years (920 years of patient support). There were 462 GI bleeding events in the 350 early survivors during the follow up time period. Figure 1 shows the relative hazard of GIB as time from heart failure diagnosis to LVAD implant increases and suggests a possible nonlinear trend for time from heart failure diagnosis to LVAD implant between 1000 and 6000 days and lowest relative hazard of GIB. There are wider confidence bands below 3000 days and above 6000 days so it cannot be concluded that hazard of GIB decreases in these ranges. This approached statistical significance (P=0.06) supporting a possible trend. GI bleeding events are common after LVAD implant and a longer preoperative duration of heart failure prior to LVAD implant may increase burden of this adverse event. This would be a powerful factor in considering someone for LVAD implant earlier rather than protracted heart failure management if clinically indicated.