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J Thorac Cardiovasc Surg 2009;137:208-215
© 2009 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Gastrointestinal bleeding rates in recipients of nonpulsatile and pulsatile left ventricular assist devices

Sheri Crow, MD, MSa,*, Ranjit John, MDb, Andrew Boyle, MDc, Sara Shumway, MDb, Kenneth Liao, MD, PhDb, Monica Colvin-Adams, MDc, Carol Toninato, RNb, Emil Missov, MDc, Marc Pritzker, MDc, Cindy Martin, MDc, Daniel Garry, MD, PhDc, William Thomas, PhDd, Lyle Joyce, MD, PhDb

a Division of Pediatric Critical Care Medicine, Mayo Clinic, Rochester, Minn
b Division of Cardiothoracic Surgery, Department of Medicine, University of Minnesota, Minneapolis, Minn
c Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, Minn
d Division of Biostatistics, Department of Medicine, University of Minnesota, Minneapolis, Minn

Received for publication April 21, 2008; revisions received June 17, 2008; accepted for publication July 6, 2008.

* Address for reprints: Sheri Crow, MD, MS, 200 First St SW, Rochester, MN 55905. (Email: crow.sheri{at}mayo.edu).

Objective: Pulsatile and nonpulsatile left ventricular assist devices are effective in managing congestive heart failure. Despite early evidence for clinical efficacy, the long-term impact of nonpulsatile flow on end-organ function remains to be determined. Our goal was to compare rates of gastrointestinal bleeding in nonpulsatile and pulsatile device recipients.

Methods: In a retrospective review of 101 left ventricular assist device recipients (55 nonpulsatile, 46 pulsatile) from October 31, 2003, to June 1, 2007, at a single center, gastrointestinal bleeding was defined as guaiac-positive stool with hemoglobin drop requiring transfusion of at least 2 units of packed red blood cells. To assess bleeding risk outside the initial postoperative course, any patients with a device in place for 15 days or less was excluded.

Results: Twelve nonpulsatile and 3 pulsatile left ventricular assist device recipients had gastrointestinal bleeding 16 days or longer after device implantation. The event rates were 63 events/100 patient-years for nonpulsatile devices and 6.8 events/100 patient-years for pulsatile devices (P = .0004). This difference persisted for bleeding occurring 31 days or longer after device implantation, with 46.5 events/100 patient-years for nonpulsatile devices versus 4.7 events/100 patient-years for pulsatile devices (P = .0028). Mortalities were similar between groups (15% nonpulsatile vs 17% pulsatile, P = .6965).

Conclusion: Patients with nonpulsatile left ventricular assist devices appear to have a higher rate of gastrointestinal bleeding events than do pulsatile left ventricular assist device recipients. Further prospective evaluation is needed to determine potential etiologies and strategies for reducing gastrointestinal bleeding in this population.

Abbreviations and Acronyms AS = aortic stenosis; AVM = arteriovenous malformation; BMI = body mass index; BTT = bridge to transplant; CHF = congestive heart failure; DT = destination therapy; FDA = Food and Drug Administration; HMW = high–molecular weight; INR = international normalized ratio; LVAD = left ventricular assist device; REMATCH = Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure; vWF = von Willebrand factor




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