Role of Pre-LVAD Endoscopic Screening and Assessment of Risk Factors Associated With Post-LVAD Implantation Gastrointestinal Bleeding

Abstract

Introduction: Left Ventricular Assist Devices (LVAD) occupy a key place in treatment for end-stage heart failure. However, around 20 - 30 % of the patients present with post-implant gastrointestinal bleed (GIB). To effectively manage the GIB in this patient population, it is vital to understand the associated risk factors and demographic parameters. Hence, we conducted this study to assess the role of pre-LVAD endoscopic screening in this population and to identify the risk factors associated with post-LVAD GIB. Methods: We performed a retrospective study at a single academic tertiary care referral center in patients who had Heart Mate IITM LVAD placed between 2010 and 2017. Various parameters, including patient demographic data, pre-LVAD endoscopic findings, history of prior GI bleed, time between LVAD implantation and admission for GIB, LVAD settings, laboratory data during admission, and endoscopic intervention utilized were analyzed. The statistical analysis was conducted using SAS v9.4. Results: 68 patients had LVAD implanted between 2011 and 2017. 25/68 patients (36.7%) had at least one admission for a GIB. Both groups (bleeders vs. non-bleeders) were similar in their demographics, pre-LVAD endoscopic screening procedures and findings (Table 1). However, those that presented with GIB were more likely to have a history of GIB prior to the implantation (p = 0.037) and an increased LVAD power (p= 0.05) (Table 1). 68% of the patients with GIB presented to the hospital within 1 year of implantation and 88% were managed in the non-ICU setting. EGD was performed in 67 % of the GIB patients and 77% of the endoscopic procedures were done within 2 days of admission. Of the patients that presented with GIB, 36% had multiple readmissions (Table 2). Compared to patients with a single GIB, the patients with multiple GIB had an increased LVAD power (p=0.036) and lower admission hemoglobin (p=0.006) (Table 2). Further, analysis revealed that patients with 3 or more readmissions for GIB had a significantly higher percentage of their first admission within 90 days of LVAD implantation (p=0.012) (Table 3). Conclusion: No significant association was seen between pre-LVAD endoscopic screening and post-LVAD admission for GIB was noted. History of prior GIB increases the risk of GIB in LVAD patients. A higher LVAD power and shorter median time between LVAD implantation and first admission (< 90 days) for GIB are significantly associated with recurrent GIB hospitalizations.567_A Figure 1 No Caption available.567_B Figure 2 No Caption available.567_C Figure 3 No Caption available.