Left Ventricular Assist Device Insertion Research Articles

(807) - Gender Trends of Left Ventricular Assist Device Insertion in Australia

(807) - Gender Trends of Left Ventricular Assist Device Insertion in Australia

Acute right ventricular geometric change predicts outcomes in HeartMate 3 patients

BackgroundThe physiological response of the right ventricle (RV) following left ventricular assist device (LVAD) implantation is difficult to predict. We aimed to investigate RV geometric and functional changes after LVAD insertion and their effects on clinical outcomes. MethodsWe retrospectively reviewed 188 patients who underwent HeartMate 3 implantation at our center between November 2014 and September 2021. The RV end-diastolic diameter (RVEDD) and area (RVEDA) were measured on preoperative and pre-discharge transthoracic echocardiography. The non-adapted group included patients with increased RVEDD and RVEDA at discharge. The composite outcome was defined as death or readmission due to worsening right heart failure. ResultsThere were 82 patients (44%) who had a non-adapted and 106 (56%) who had an adapted RV. Preoperatively, the non-adapted group had smaller RVEDD (46 vs. 49 mm, p < 0.001) and RVEDA (27 vs. 31 cm2, p < 0.001). At discharge, the non-adapted group had larger RVEDD (51 vs. 43 mm, p < 0.001) and RVEDA (33 vs. 27 cm2, p < 0.001). Kaplan-Meier analysis demonstrated worse 3-year survival (77% vs. 91%, p = 0.006) and freedom from composite outcome (58% vs. 85%, p < 0.001) in the non-adapted group. A multivariable Cox proportional hazards model showed that non-adaption (HR 3.09, 95% CI 1.29–7.40 p = 0.01) and age (HR 3.73, 95% CI 1.42–9.77, p = 0.007) were independent predictors of composite outcome. ConclusionsAcute RV dimensional changes after LVAD insertion may represent intrinsic RV function and may be a useful prognostic marker.

Abstract 18088: Survival After Ventricular Tachycardia Onset in Left Ventricular Assist Device Recipients

Introduction: Left Ventricular Assist Devices (LVADs) revolutionized the care of patients with heart failure. However, the burden of ventricular tachycardia (VT) increases after LVAD insertion. The role of ablation in treating VT in LVAD recipients is unclear. Hypothesis: The incidence of VT following LVAD insertion is associated with worse survival, but this association is ameliorated by VT ablation. Methods: This is a single-center retrospective review of 549 LVAD recipients. LVADs implanted elsewhere, LVADs prior to 2011, and patients with inadequate follow up were excluded. Endpoints were transplantation, explantation, and last date of follow up. Event failure was defined as patient death. Cox and Kaplan-Meier survival analysis was performed with STATA and reported as hazard ratio with 95% confidence interval (HR [95% CI]). Results: Pre-LVAD VT was seen in 52% of patients: 33% had a prior ICD shock and 12% had a prior VT ablation. At study conclusion, 57% had died, 22% were transplanted, 9% were explanted, and 12% remained alive. Regardless of VT incidence, worse survival was seen in ischemic cardiomyopathy (HR 2.0 [1.5-2.7]), RV failure necessitating RVAD (HR 2.6 [1.9-3.6]), and pre-LVAD ICD shocks (HR 1.3 [1.0-1.7]). While post-LVAD VT overall was not associated with worse survival (HR 1.1 [0.8-1.3]), VT within 1 year of LVAD insertion demonstrated worse survival (HR 1.9 [1.3-2.6]; Figure 1). Incremental years between LVAD insertion and VT onset improved survival (HR 0.8 [0.7-0.9]). Among those with post-LVAD VT, ablation was not associated with a survival difference (IRR 0.9 [0.6-1.4]) regardless of the timing of ablation or VT onset. Conclusions: The incidence of VT within 1 year of LVAD insertion is associated with worse survival. However, mortality was not improved by VT ablation. This study is limited by its retrospective design, and further prospective studies would better determine the impact of VT ablation on survival in LVAD recipients.

Discussion to: Association of timing of percutaneous left ventricular assist device insertion with outcomes in patients undergoing cardiac surgery

Discussion to: Association of timing of percutaneous left ventricular assist device insertion with outcomes in patients undergoing cardiac surgery

Association of timing of percutaneous left ventricular assist device insertion with outcomes in patients undergoing cardiac surgery

ObjectivesThe aim of this study was to explore the associations between percutaneous ventricular assist device (pVAD) insertion timing relative to cardiac surgery and patient outcomes. MethodsThe Nationwide Inpatient Sample was queried for patients undergoing cardiac surgery and pVAD insertion in the same admission from 2016 to 2019. Patients were stratified by timing of pVAD insertion. Preoperative characteristics, postoperative complications, and mortality were compared among groups. ResultsOverall, 3695 patients underwent cardiac surgery and pVAD insertion during the same hospitalization (pre: 1130, intra: 1690, and post: 875). The distribution of cardiac surgery procedures was similar across groups. Median Elixhauser Comorbidity Index was 13 for pre-, 15 for intra-, and 17 for postoperative pVAD patients (P = .021). Patients who received a postoperative pVAD were associated with increased mortality (pre: 18%, intra: 39%, and post: 54%; P < .01). Increased complication rates were also associated with postoperative pVAD insertion (pre: 61%, intra: 55%, and post: 75%; P < .01). Preoperative pVAD insertion was associated with increase rates of sepsis (pre: 18%, intra: 9.8%, and post: 17%; P = .01) and pneumonia (pre: 38%, intra: 23%, and post: 31%; P < .01). Postoperative pVAD insertion was associated with increased rates of gastrointestinal bleeding (pre: 2.2%, intra: 3.0%, and post: 7.4%; P = .01), renal failure (pre: 10%, intra: 9.2%, and post: 17%; P = .01), and prolonged ventilation (pre: 44%, intra: 41%, and post: 54%; P = .02). ConclusionsPostoperative pVAD insertion following cardiac surgery was associated with increased complications and mortality compared with preoperative or intraoperative insertion. Further studies should explore optimal utilization and timing of pVAD insertion in patients undergoing cardiac surgery.

Impact of Frailty on Left Ventricular Assist Device Clinical Outcomes

Frailty is a clinical syndrome prevalent in older adults and carries poor outcomes in patients with heart failure.We investigated the impact of frailty on left ventricular assist device (LVAD) clinical outcomes. The Nationwide Readmission Database was used to retrospectively identify patients with a primary diagnosis of heart failure who underwent LVAD implantation during their hospitalization from 2014 to 2020. Patients were categorized into frail and nonfrail groups using the Hospital Frailty Risk Score. Cox and logistic regression were used to predict the impact of frailty on inpatient mortality, 30-day readmissions, length of stay, and discharge to a skilled nursing facility.LVADs were implanted in 11,465 patients who met the inclusion criteria. There was more LVAD use in patients who were identified as frail (81.6% vs 18.4%, p <0.001). The Cox regression analyses revealed that LVAD insertion was not associated with increased inpatient mortality in frail patients (hazard ratio 1.15, 95% confidence interval 0.81 to 1.65, p=0.427). Frail patients also did not experience a higher likelihood of readmissions within 30days (hazard ratio 1.15, 95% confidence interval 0.91 to 1.44, p=0.239).LVAD implantation did not result in a significant increase in inpatient mortality or readmission rates in frail patients compared with nonfrail patients. These data support continued LVAD use in this high-risk patient population.

Management of Vasoplegic Shock in Left Ventricular Assist Device Insertion Procedures.

Management of Vasoplegic Shock in Left Ventricular Assist Device Insertion Procedures.

(289) Does Lateral Approach Preserve Better Right Ventricular Function after Left Ventricular Assist Device Insertion?

(289) Does Lateral Approach Preserve Better Right Ventricular Function after Left Ventricular Assist Device Insertion?

Tricuspid valve surgery at the time of left ventricular assist device insertion-digging deeper.

Tricuspid valve surgery at the time of left ventricular assist device insertion-digging deeper.

Prophylactic LVAD for high-risk patients undergoing cardiac surgery.

Postcardiotomy cardiogenic shock (PCS) is associated with poor prognosis. Medical therapy with afterload reduction, contractility optimization and systemic vasopressors often fails, and mechanical support is required. The aim of this study was to propose a strategy of prophylactic left ventricular assist device (LVAD) for high-risk patients undergoing cardiac surgery. Between 2013 and 2019, 12 consecutive patients at high risk for PCS underwent cardiac surgery (valve surgery and/or coronary artery bypass grafting) with preplanned, prophylactic implantation of LVAD (CentriMag or Rotaflow). We reviewed patient characteristics and outcomes. Eight patients underwent a valve corrective surgery and sevenpatients underwent coronary artery bypass grafting. Eleven of 12 patients had successful LVAD insertion, support and wean, and survival to hospital discharge. Left ventricular function was stable perioperatively and improved at follow-up. Patients required low doses of inotropic support and no patients required extracorporeal membranous oxygenation. Major complications included, prolonged mechanical ventilation (n = 7), intra-aortic balloon pump (n = 1), temporary dialysis (n = 2), stroke (n = 1), bleeding requiring reoperation (n = 3), infection requiring mediastinal washout (n = 1). At a mean follow-up of, 660 ± 460.6 days all patients had either NYHA Class 1 (n = 6) or 2 (n = 4). There were two late mortalities (after 1 year). Prophylactic LVAD is a viable technique in select cardiac surgery patients who are high-risk for postcardiotomy shock. Further prospective study is warranted.

Ventricular tachycardia mechanisms and prevention in patients with severe heart failure and left ventricular assist device

Abstract Terminal Heart Failure with reduced Ejection Fraction (HFrEF) is associated with severe morbidity and mortality. Mechanical Left Ventricular Assist Devices (LVAD) are often used to provide these patients with a last resort therapy and as bridge to transplant. However, HFrEF patients with LVAD have significant myocardial substrate for ventricular arrhythmias and the LVAD itself might be regarded as pro-arrhythmogenic. Aim of the current study was to investigate the mechanism of ventricular arrhythmias in LVAD patients and to provide evidence for the hypothesis that ad-hoc ablation/substrate modification during surgical LVAD implantation might reduce the risk of VT. We retrospectively analyzed invasive ablation procedures in patients with VT±LVAD and determined the mechanism of arrhythmia during electrophysiological examination (using 3D electroanatomical and local activation time mapping; Carto; Biosense Webster) in LVAD (n=17) and non-LVAD (n=12) subgroups. Mean age of the predominantly male (97%) patients was 60±2 years. VTs were directly LVAD associated (i.e. focal, adjacent to LVAD insertion or macro-reentry, around LVAD) in almost half of the LVAD patients. Number of radiofrequency ablation (RF) lesions and RF time were not significantly different between LVAD associated VT and non-LVAD associated VT patients. Within the LVAD patient group, freedom from VT (mean follow-up 40±6 months) was 50% upon ablation in patients with VTs originating from the LVAD region and 70% if ablation was conducted in non-LVAD regions. None of the LVAD associated and 22% of non-LVAD associated VT patients died during follow-up of these critically ill patients. Moreover, to reduce LVAD related arrhythmias and based on additional ex-vivo/in-silico derived data, we propose a distinctive (i.e. “star” shaped, LVAD encirclement) epicardial substrate modification during surgical LVAD implantation. In summary, a significant percentage of patients with LVAD exhibit LVAD-associated focal/macro-reentry VT and recurrence rates are high. VT likelihood is reduced ex-vivo/in-silico upon substrate modification targeting myocardium adjacent to a possible LVAD implantation site. Epicardial RF ablation during surgical LVAD implantation might allow prevention of LVAD-associated focal/macro-reentry VT. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): DFG

Outcomes of treatment for deep left ventricular assist device infection

ObjectiveAmong left ventricular assist device patients, the most commonly infected component is the drive line, which can be managed with antibiotics and local debridement. Infection of intrathoracic device components is less common but more difficult to manage. Herein we describe the incidence of deep device infection (DDI) at our center as well as management and outcomes. MethodsWe retrospectively reviewed 658 patients who underwent implantable left ventricular assist device insertion with HeartMate 2 (Abbott) or HeartMate 3 (Abbott) devices between January 2004 and June 2021. DDI was defined according to radiographic and clinical criteria. Cumulative incidence was calculated using a Fine-Gray subdistribution model; survival analysis was performed using the method of Kaplan and Meier. ResultsThere were 32 (4.8%) DDIs during this study period. Drive line infection and re-exploration for bleeding were associated with development of DDI. Cumulative incidence of DDI increased over time, affecting 11% (7%-18%) at 5 years. The dominant microbes involved in DDI were Pseudomonas aeruginosa (19%) and methicillin-resistant Staphylococcus aureus (13%). Nineteen patients (59%) with device infection underwent device exchange, 6 (19%) underwent initial transplant, and 7 (22%) were treated solely with debridement and antibiotics. Of those who underwent device exchange, 12 (63%) developed reinfection of their new device and 6 underwent subsequent heart transplant. Patients who underwent transplantation for management of device infection had improved 5-year survival (80% vs 11%; P = .01) but 3 patients (25%) developed deep sternal wound infection after transplant. ConclusionsDDI is a rare but challenging complication in this destination era. Heart transplantation is the preferred management strategy for eligible patients but infectious complication is common.

Perioperative Ischemic Optic Neuropathy after Cardiac Surgery: Development and Validation of a Preoperative Risk Prediction Model

ObjectivePrevious studies identified risk factors for ischemic optic neuropathy (ION) after cardiac surgery; however, there is no easy-to-use risk calculator for the physician to identify high-risk patients for ION before cardiac surgery. The authors sought to develop and validate a simple-to-use predictive model and calculator to assist with preoperative identification of risk and informed consent for this rare but serious complication. DesignRetrospective case-control study. SettingHospital discharge records. PatientsA total of 5,561,177 discharges in the National Inpatient Sample >18 years of age, with procedure codes for coronary artery bypass grafting, heart valve repair/replacement, or left ventricular assist device insertion. InterventionsAll patients had undergone cardiac surgery. Measurements and Main ResultsKnown preoperative risk factors for ION after cardiac surgery were assessed to develop a risk score and prediction model. This model was validated internally using the split-sample method. There were 771 cases of ION among 5,561,177 patients in the National Inpatient Sample. The risk factors for ION used in the model were carotid artery stenosis, cataract, diabetic retinopathy, macular degeneration, glaucoma, male sex, and prior stroke; whereas uncomplicated diabetes decreased risk. With the internal validation, the predictive model had an area under the receiver operating characteristic curve of 0.66. A risk score cutoff ≥3 had 98.4% specificity. ConclusionsThis predictive model, based on previously identified preoperative factors, predicted risk of perioperative ION with a fair area under the receiver operating characteristic curve. This predictive model could enable screening to provide a more accurate risk assessment for ION, and consent process for cardiac surgery.

Minimally Invasive Left Ventricular Assist Device Insertion with Concomitant Aortic Valve Replacement Despite Prior Sternotomy

<h3>Introduction</h3> Minimally-invasive approaches to left ventricular assist device (LVAD) insertion have been described. However, reoperative sternotomy and/or need for concomitant procedures have been regarded as relative contraindications to a minimally-invasive approach. <h3>Case Report</h3> A 61 year-old female with ischemic cardiomyopathy and prior coronary bypass grafting via median sternotomy was deemed an appropriate candidate for LVAD insertion. While preoperative echocardiography demonstrated mild aortic insufficiency, intra-operative imaging revealed moderate aortic insufficiency. Intra-operatively, the aorta was accessed via a partial upper sternotomy to the 4^th intercostal space. The ventricular apex was accessed through a left anterolateral thoracotomy. Cardiopulmonary bypass was established via an aortic cannula inserted via the ascending aorta and a multi-stage venous cannula inserted into the right femoral vein. Cardioplegia was administered first via an antegrade aortic root catheter, and then later via retrograde catheter and direct coronary ostial cannulation during the valve replacement. The aortic valve was replaced with a 21-mm bioprosthetic valve via the partial sternotomy (Fig A). After aortotomy closure, the cross-clamp was removed and the heart re-perfused. An apical ventriculotomy was then created and the LVAD inflow cannula was inserted into the left ventricle and secured to the sewing ring (Fig B). The outflow graft was tunneled to the upper sternotomy and anastomosed to the aorta using a side-biting clamp. The postoperative course was notable for pneumonia leading to temporary re-intubation. She otherwise did well, and was discharged home on post-LVAD day 23. <h3>Summary</h3> Both a history of a prior sternotomy and the need for concomitant procedures present challenges to use of minimally-invasive approaches for LVAD insertion. Here, we demonstrate that concomitant AVR can be safely performed along with LVAD insertion in a reoperative setting.

Exploring the Benefit of Thoracotomy LVAD Implant on Subsequent Sternal Entry for Heart Transplantation

<h3>Purpose</h3> Minimally invasive left ventricular assist device (LVAD) implantation via left thoracotomy has previously been shown to be a safe operation with potential advantages compared to sternotomy. These advantages include improved inflow cannula positioning as well as minimising adhesions for subsequent sternal entry for heart transplantation. We wanted to assess the impact of LVAD implant technique on subsequent heart transplantation. <h3>Methods</h3> All patients who received an LVAD via thoracotomy and subsequently transplanted were included. This group was matched 2:1 with patients who received an LVAD via sternotomy and were subsequently transplanted. Patients in the sternotomy group were excluded if they had a prior sternotomy to LVAD insertion. Parameters such as cardiopulmonary bypass time, blood usage, post-operative length of stay, morbidity and mortality measures were extracted. <h3>Results</h3> 12 Thoracotomy patients and 24 sternotomy patients were included in the study. There was no significant difference in gender, BMI or age between the two groups. When assessing operation variables, there was no significant difference in operation duration, cardiopulmonary bypass time or cross clamp time between the sternotomy and thoracotomy groups. Similarly, there was no significant difference in blood product administration (red blood cells, cryoprecipitate, fresh frozen plasma, platelets) intraoperatively. There was no difference in total length of stay, ICU length of stay, ventilation time and 30-day mortality. <h3>Conclusion</h3> In our sample size of 36 patients, we could not demonstrate a significant difference in peri-operative variables between VAD patients who presented for their heart transplant subsequent to receiving an LVAD implanted via either sternotomy or thoracotomy. These findings suggest that while thoracotomy for LVAD insertion may present advantages such as improved inflow cannula positioning, we could not demonstrate a clear benefit in sternal entry for subsequent transplant.

Carotid Endarterectomy Prior to Ventricular Assist Device Placement in a Patient with Cardiogenic Shock

<h3>Introduction</h3> Atherosclerotic disease in the cervical vessels may be a contraindication for implantation of left ventricular assist devices (LVADs). The occurrence of ischemic stroke represents an obstacle to rehabilitation, and its incidence seems to be higher in this population. Carotid endarterectomy (CEA) is a preferable surgical treatment in patients with high bleeding risk. This case report suggests that CEA followed by implantation of LVADs can be feasible. <h3>Case Report</h3> A 55 y/o woman with advanced heart failure (AHF) due to ischemic cardiomyopathy was admitted in the hospital with cardiogenic shock and started treatment. She evolved with three failures in weaning the inotropic agent, and was evaluated for heart transplantation (HT). She had a panel-reactive antibody with 79% class II and a critical right carotid artery stenosis was evidenced. She had preserved right ventricular function; consequently, implantation of LVAD was an option. However, she presented an episode of hypotension, dysarthria and left hemiparesis in the preoperative period that reversed after intra-aortic balloon (IAB) placement and hemodynamic stabilization. Computed tomography angiography showed right internal carotid artery sub-occlusion and transcranial Doppler ultrasound with the cerebral flow within normal range despite hemodynamic support. CEA of both the right internal and common carotid artery was performed. The patient tolerated the procedure despite using inotropic and IAB, recovering with no neurological deficit. Heart Mate III was implanted after 15 days. The patient evolved well and is currently in an outpatient follow-up for 1 year. <h3>Summary</h3> The appropriate interval between CEA and LVAD implantation is not well established; however, we assume that early intervention might reduce a cerebral ischemic event's risk. If a stroke occurred during LVAD implantation, rehabilitation would be expensive and complex, and future HT might be contraindicated. The team agreed that the most appropriate technique, in this case, was CEA instead of percutaneous stent implantation as the second technique would require dual antiplatelet therapy. With the increasing number of patients with AHF undergoing LVAD, comorbidities such as severe cerebrovascular disease may occur. This case report suggests that CEA followed by LVAD insertion can be safe and feasible even in cardiogenic shock.

Analysis Paralysis: Transition to HeartMate 3 Left Ventricular Assist Device Despite Multiple Complications from COVID-19

IntroductionWe present a case of a 39 year old male with nonischemic cardiomyopathy who was successfully bridged to HeartMate3 Left Ventricular Assist Device (LVAD) despite multiple life threatening complications secondary to Covid-19.Case Report39-year-old male with past medical history notable for tobacco abuse and recently diagnosed non-ischemic cardiomyopathy presented to our institution with NYHA Class IV symptoms and was found to be in cardiogenic shock. On admission Covid-19 PCR was negative. He initially responded to the initiation of inotropic support and aggressive diuresis with normalization of his end-organ function and improvement in his symptoms over three days. He suddenly experienced rapid hemodynamic decline necessitating escalation of inotropic and mechanical circulatory support with VA ECMO and Impella 5.5. On that day, his wife felt unwell and was found to be positive for Covid-19. The patient's Covid-19 PCR was repeated and also positive. He underwent treatment with Regeneron. His hospital course was further complicated by multiple sequelae of Covid-19 including pneumonia, acute renal failure necessitating hemodialysis (HD), and Guillain Barre Syndrome (GBS) presenting with bilateral ascending paralysis extending to his hip flexors, improved with intravenous immune globulin (IVIG) therapy.Over a period of two weeks, he demonstrated improvement and was weaned from VA ECMO to Impella 5.5. Unfortunately, he was unable to tolerate weaning the Impella 5.5. He was aggressively rehabilitated. After extensive multidisciplinary discussion, LVAD implantation was recommended to the patient. Following insertion of a HeartMate3 LVAD, the patient demonstrated renal recovery and ongoing improvement in physical ability. He was discharged to an acute rehabilitation facility and was subsequently discharged home. He will be monitored for listing for cardiac transplantation pending abstinence from tobacco use.SummaryCovid-19 can present with multiple life threatening complications that can add novel challenges to the management of patients with stage D cardiomyopathy. Despite complications of acute renal failure and paralysis secondary to GBS from Covid-19, our patient was successfully supported with temporary mechanical circulatory support, aggressively rehabilitated, and transitioned to a durable HeartMate 3 LVAD.

Cardiac rehabilitation in a heart failure patient after left ventricular assist device insertion and subsequent heart transplantation: A case report

BACKGROUNDInsertion of a left ventricular assist device (LVAD) and heart transplantation (HT) improve the survival of patients with heart failure. In addition, cardiac rehabilitation (CR) further increases the functional capacity. This case report describes a successful case of CR after LVAD insertion and subsequent HT.CASE SUMMARYIn the present case, during the LVAD insertion period, peak oxygen consumption (VO2) increased by 12.16% after CR. HT was performed 7 mo after the LVAD insertion, and the patient participated in phases I and II CR. The peak VO2 increased from 17.24 to 22.29 mL/kg/min. This improvement was more significant than that reported in previous studies on CR after LVAD insertion or HT. The patient’s quality of life also improved. The total average score of the short form-36 questionnaire increased from 29.5 points at admission to 53.3 points 9 mo after HT.CONCLUSIONA tailored CR program after LVAD insertion or HT may improve the patients’ quality of life and increase survival.

Catheter‐based system for the treatment of left ventricular assist device thrombosis

Thrombotic complications continue to pose challenges to patients on left ventricular assist device (LVAD) support. The Hoplon system was developed to administer catheter-based lytic therapy with a novel approach to embolic protection. Two porcine non-survival surgeries were performed in which off-pump LVAD insertion was followed by injection of thrombus into the impeller, isolation of the pump using the Hoplon system, and administration of lytic therapy to the pump chamber. Successful thrombus resolution was confirmed by pathological examination of the LVAD and brain tissue after animal sacrifice. Limitations of the prototype design resulted in the extrusion of thrombus from around the catheter in the first animal. Subsequent device modifications resulted in the resolution of LVAD thrombus as confirmed on removal and examination of the pump. Pathological examination of the brain tissue revealed the absence of any embolic or hemorrhagic complications. Early animal studies suggest feasibility in restoring function to an LVAD while at the same time preventing cerebroembolic events using the Hoplon system.

Abstract 9779: The Utility of Endoscopic Screening in Mitigating the Risk of Gastrointestinal Bleeding After Left Ventricular Assist Device Placement. A Retrospective Chart Review Study

Introduction: Left ventricular assist device (LVAD) is a lifesaving bridge to transplantation or destination therapy for patients with end-stage heart failure. More than one-third of patients suffer from gastrointestinal (GI) bleeding within one year of placement. We investigated the yield and safety of endoscopic screening for potential sources of GI bleeding before LVAD insertion. Hypothesis: Endoscopic screening prior to LVAD placement does not necessarily reduce the risk of GI bleed post LVAD. Methods: We performed a retrospective chart review study of patients at Saint Luke’s Mid America Heart Institute who underwent continuous-flow LVAD implantation from 2010 to 2020. Study participants were categorized based on whether or not they underwent screening endoscopy prior to LVAD implantation. Patients were followed for one year after implantation, and outcomes were collected to determine the yield and safety of these procedures. A multivariable logistic regression analysis was performed using SPSS® controlling for the following confounding factors: age, gender, race, and history of GI bleeding. Results: Among 205 patients with an LVAD, 169 patients were included in the study after excluding those with lack of data or those lost to follow up. 68 (40.23%) patients who received pre-LVAD screening by either upper and/or lower endoscopies, and 42 (24.85%) patients who had post-LVAD GI bleed. Patients who underwent pre-LVAD screening had similar rates of GI bleeding after LVAD compared to those who were not screened (odds ratio 1.66, 95% CI 0.648-4.264, P=0.2). Moreover, in patients with post LVAD GI bleed, endoscopy findings were typically different than those pre LVAD. No complications to the endoscopic interventions were reported. Conclusions: While endoscopic screening appears to be safe in patients before LVAD implantation, it had no association with GI bleeding risk or etiology after LVAD.