Preoperative Right-Sided Cardiac Congestion Is Associated with Gastrointestinal Bleeding in Patients with Continuous-Flow Left Ventricular Assist Devices

Background Large scale data on preoperative risk stratification for gastrointestinal bleeding (GIB) following continuous-flow left ventricular assist device (CF-LVAD) implantation are scarce. Aims To identify independent predictors for GIB following CF-LVAD implantation. Methods We conducted a retro...

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Bibliographic Details
Published in:Digestive diseases and sciences 2018-06, Vol.63 (6), p.1518-1524
Main Authors: Tomizawa, Yutaka, Tanaka, Akiko, Kitahara, Hiroto, Sakuraba, Atsushi, Uriel, Nir, Jeevanandam, Valluvan, Ota, Takeyoshi
Format: Article
Language:English
Subjects:
Biochemistry
Care and treatment
Catheters
Gastroenterology
Gastrointestinal bleeding
Heart failure
Hemoglobin
Hepatology
Medical centers
Medical research
Medicine
Medicine & Public Health
Medicine, Experimental
Oncology
Original Article
Pulmonary arteries
Transplant Surgery
Venous pressure
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Summary:Background Large scale data on preoperative risk stratification for gastrointestinal bleeding (GIB) following continuous-flow left ventricular assist device (CF-LVAD) implantation are scarce. Aims To identify independent predictors for GIB following CF-LVAD implantation. Methods We conducted a retrospective cohort study of consecutive 243 patients who underwent CF-LVAD implantation (HeartMateII) from January 2009 to March 2015 at the University of Chicago Medical Center. GIB was defined as the presence of overt bleeding or occult GIB with ≥ 2 g/dl drop in hemoglobin (Hgb) from recorded baseline values and hemoccult-positive stool. The preoperative and postoperative data were reviewed. Results Within a median follow-up duration of 408 (IQR 113–954) days, 83 (34%) patients developed GIB after a median of 149 (IQR 27–615) days after implantation of CF-LVAD. There were no significant differences between the groups of GIB and non-GIB with respect to preoperative demographics and comorbidity except for ethnicity. The source of bleeding was identified in 39 (47%) patients and arteriovenous malformation or submucosal streaming vessel was the most frequent cause of bleeding (18/39, 46%). Multivariate-adjusted analysis demonstrated preoperative central venous pressure (CVP) ≥ 18 mmHg (HR 3.56; 95% CI 1.16–10.9; p  = 0.026), mean pulmonary artery pressure (mPA) ≥ 36 mmHg (HR 4.14; 95% CI 1.35–12.7; p  = 0.013), and the presence of moderate/severe tricuspid valve disease (HR 1.01; 95% CI 1.01–3.86; p  = 0.046) were associated with the risk of GIB. Conclusions In this study, preoperative right-sided cardiac congestion (i.e., increased CVP, mPA and the presence of moderate/severe tricuspid valve disease) was associated with GIB in patients with CF-LVAD.
ISSN:0163-2116
1573-2568
DOI:10.1007/s10620-018-4916-8