Impact of Gastrointestinal Bleeding Burden with Subsequent Outcomes after Left Ventricular Assist Device Implant

Abstract

Gastrointestinal bleeding (GIB) is a frequent post left ventricular assist device (LVAD) co-morbidity, and many patients require multiple endoscopic interventions. While GI bleeding events have been shown to impact subsequent outcomes, the association of the burden of GI bleeding interventions with subsequent outcomes has not been specifically analyzed. 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. During these 462 bleeding events, endoscopic procedures were performed in 341/462 instances (74%) and intervention was performed in 96/341 (28%). Figure 1 shows the relative hazard of outcomes as related to burden of GI interventions for bleeding; late survival (p=0.95) and thrombotic complications (p=0.69) were not significantly impacted by increasing number of required GI interventions. However, risk of subsequent stroke (p=0.04) was significantly increased with higher number of procedures required. GI bleeding events are common after LVAD implant and endoscopic interventions are often required. Anticoagulation cessation is often required during these instances, and subsequent risk of stroke may be increased as the number of these procedures required is increased. Careful attention to peri-procedural anticoagulation and management may be critical to reduce subsequent unintended adverse events.