Stopping LVAD Bleeding: A Piece of the Puzzle.

Abstract

Left ventricular assist devices (LVADs) are efficient pumps that assist the circulation. They are rapidly evolving and being inserted into an increasing number of patients with advanced heart failure either as a bridge to transplantation or increasingly as destination therapy. The epidemic of heart failure is only likely to worsen as the population ages. Although medical therapy has improved the survival of many, there remain a large group of patients who, despite optimal medical therapy, deteriorate and develop advanced heart failure. Although heart transplantation is highly successful for these patients, unfortunately the number of useable donor hearts is totally inadequate for the population that need them. Article, see p 963 The number of pumps being implanted has particularly increased since the introduction of the continuous-flow (CF) pumps, which have almost replaced the pulsatile pumps. They have far better survival and longer durability but are associated with significant bleeding complications. Gastrointestinal bleeding is a huge problem after LVAD implantation. Its incidence has been estimated between 15% and 61%,1 and a meta-analysis has shown a pooled prevalence of 23% in LVAD recipients.2 The CF pumps are associated with a much higher incidence of gastrointestinal bleeding compared with the earlier pulsatile LVADs (where the incidence was ≈10%), and patients are 4.5 to 10× more likely to experience gastrointestinal bleeding depending on the series.2–4 LVAD recipients also have a greater severity of gastrointestinal bleeds than the general population, requiring an average of 2 to 4 U of packed red blood cells per admission and have a high rate of rebleeding of around 35%.4 LVAD-associated LVAD gastrointestinal bleeding is associated with significant morbidity, hospital readmissions, and cost. The increased morbidity …