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Arteriovenous malformation and gastrointestinal bleeding in patients with the HeartMate II left ventricular assist device
Demirozu, Zumrut T. ...
Background In this study we investigated gastrointestinal (GI) bleeding and its relationship to arteriovenous malformations (AVMs) in patients with the continuous-flow HeartMate II (HMII) left ...ventricular assist device (LVAD). Methods The records of 172 patients who received HMII support between November2003 and June 2010 were reviewed. Patients were considered to have GI bleeding if they had 1 or more of the following symptomsČ guaiac-positive stoolč hematemesisč melenač active bleeding at the time of endoscopy or colonoscopyč and blood within the stomach at endoscopy or colonoscopy. The symptom(s) had to be accompanied by a decrease of >1 gždl in the patientćs hemoglobin level. The location of the bleeding was identified as upper GI tract, lower GI tract or both according to esophagogastroduodenoscopy, colonoscopy, small-bowel enteroscopy or mesenteric angiography. Post-LVAD implantation anti-coagulation therapy consisted of warfarin, aspirin and dipyridamole. Results Thirty-two of the 172 patients (19%) had GI bleeding after 63 62 (range 8 to 241) days of HMII support. Ten patients had GI bleeding from an AVMč these included 3 patients who had 2 bleeding episodes and 2 patients who had 5 episodes each. Sixteen patients had upper GI bleeding(10 hemorrhagic gastritis, 4 gastric AVM, 2 Mallory-Weiss syndrome), 15 had lower GI bleeding (6 diverticulosis, 6 jejunal AVM, 1 drive-line erosion of the colon, 1 sigmoid polyp, 1 ischemic colitis) and 1 had upper andlower GI bleeding (1 colocutaneous and gastrocutaneous fistula). All GI bleeding episodes were successfully managed medically. Conclusions Arteriovenous malformations can cause GI bleeding in patients with continuous-flow LVADs. In all cases in this series, GI bleeding was successfully managed without the need for surgical intervention.
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