The Predicament of Gastrointestinal Bleeding in Patients With a Continuous-Flow Left Ventricular Assist Device: Pathophysiology, Evaluation, and Management

Heart failure affects over 5 million Americans, with numbers expected to rise. While heart transplantation is the most effective long-term strategy for end-stage heart failure, there is a limited cardiac donor pool, and these organs are often unavailable at the time of need. Left ventricular assist devices, therefore, continue to be used to bridge this gap. Originally implanted as a bridge to transplant, these devices are now additionally utilized as destination therapy for patients ineligible for transplant. With the widespread applicability of these devices for not just temporary measures, but also for prolonged use, the short- and long-term impact on other organ systems has become more evident. For example, gastrointestinal (GI) bleeding, with an incidence approaching 30%, is one such complication post–continuous-flow left ventricular assist device implantation. This high incidence of GI bleeding is thought to stem from a combination of factors, including the need for concomitant anticoagulant and antiplatelet therapy, and intrinsic device-related properties resulting in acquired Von Willebrand disease and arteriovenous malformations. Due to the significant morbidity associated with these GI bleeding events, a standardized protocol optimizing medical and endoscopic management, alongside close coordination between the gastroenterology and cardiology services, should be advocated for and ultimately employed.
Source: Cardiology in Review - Category: Cardiology Tags: Review Articles Source Type: research

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Authors: den Exter PL, Beeres SLMA, Eikenboom J, Klok FA, Huisman MV Abstract INTRODUCTION: The treatment options for advanced heart failure patients drastically changed with the introduction of left ventricular assist devices (LVADs), either as bridge to transplant or as destination therapy for patients ineligible for transplant. Despite major benefits in terms of survival, functional status and quality of life, managing patients with LVADs comes with several challenges. The most significant challenge is balancing between the risks of thrombotic and bleeding complications. AREAS COVERED: The present review des...
Source: Expert Review of Cardiovascular Therapy - Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research
Authors: Leebeek FWG, Muslem R Abstract Chronic heart failure (HF) is a growing health problem, and it is associated with high morbidity and mortality. Left ventricular assist devices (LVADs) are nowadays an important treatment option for patients with end-stage HF not only as a bridging tool to heart transplantation but also, as a permanent therapy for end-stage HF (destination therapy). The use of LVAD is associated with a high risk for bleeding complications and thromboembolic events, including pump thrombosis and ischemic stroke. Bleeding is the most frequent complication, occurring in 30% to 60% of patients, b...
Source: Hematology ASH Education Program - Category: Hematology Tags: Hematology Am Soc Hematol Educ Program Source Type: research
Mechanical circulatory support devices are needed to enable recovery or provide a bridge to decision for patients with heart failure. The effectiveness of extending treatment duration in this therapy was previously reported to increase adverse events, such as acquired von Willebrand disease and gastrointestinal bleeding. Blood-related damage caused by medical devices is one of the most critical parameters needed to determine the performance of medical devices. For the treatment of these complications, we considered that it is very important to analyze the relationship between the cleavage of von Willebrand factor (VWF) due...
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: 1083 Source Type: research
Gastrointestinal (GI) bleeding, primarily manifesting as angiodsyplasia (AGD) is one of the most common and challenging complications post CF LVAD. The possible mechanisms underlying LVAD induced AGD formation are the subject of intense research efforts and have focused on an association with low or absent pulsatility and acquired type 2A von Willebrand factor deficiency (vWD). We have previously reported a high prevalence of nasal mucosal vascular malformations, a possible surrogate marker for AGD, in patients with heart failure (HF) prior to LVAD implant.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Source Type: research
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Source: Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy - Category: Drugs & Pharmacology Authors: Tags: Review of Therapeutics Source Type: research
Abstract Continuous-flow left ventricular assist devices (CF-LVADs) have significantly improved outcomes for patients with end-stage heart failure when used as a bridge to cardiac transplantation or, more recently, as destination therapy. However, its implantations carries a risk of complications including infection, device malfunction, arrhythmias, right ventricular failure, thromboembolic disease, postoperative and nonsurgical bleeding. A significant number of left ventricular assist devices (LVAD) recipients may experience recurrent gastrointestinal hemorrhage, mainly due to combination of antiplatelet and vita...
Source: World Journal of Gastroenterology : WJG - Category: Gastroenterology Authors: Tags: World J Gastroenterol Source Type: research
Over the past decade, continuous-flow rotary pumps have dramatically improved survival for patients with advanced systolic heart failure. Bleeding and thrombosis, however, continue to be the Achilles heel of left ventricular assist device (LVAD) therapy. There is a dynamic and complex interaction between the patient and pump. The net effect of a variety of hematologic derangements, such as hemolysis, high-molecular-weight von Willebrand degradation, platelet activation and diminished pulsatility, is poorly understood.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: State of the Art Source Type: research
Left ventricle assist devices (LVADs) have significantly improved the survival of patients with end-stage heart failure, but device-related hemostatic complications remain common and are associated with poor outcomes. The bleeding diathesis, primarily found in gastrointestinal (GI) tract at the site of an arteriovenous malformation,1,2 is believed to be caused by the loss of large von Willebrand factor (VWF) in plasma, leading to the term of acquired von Willebrand syndrome (AVWS). LVAD-associated AVWS is believed to be caused by the excessive cleavage of large VWF multimers by the metalloprotease ADAMTS-13 (a disintegrin ...
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Source Type: research
Conclusions In summary, GI bleeding with LVADs is a common occurrence and will continue to be as more LVADs are being performed for destination therapy.
Source: Digestive Diseases and Sciences - Category: Gastroenterology Source Type: research
Authors: Hudzik B, Kaczmarski J, Pacholewicz J, Zakliczynski M, Gasior M, Zembala M Abstract Mechanical circulatory support (MCS) is an umbrella term describing the various technologies used in both short- and long-term management of patients with either end-stage chronic heart failure (HF) or acute HF. Most often, MCS has emerged as a bridge to transplantation, but more recently it is also used as a destination therapy. Mechanical circulatory support includes left ventricular assist device (LVAD) or bi-ventricular assist device (Bi-VAD). Currently, 2- to 3-year survival in carefully selected patients is much bette...
Source: Polish Journal of Cardio-Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Tags: Kardiochir Torakochirurgia Pol Source Type: research
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