Faculty Collaboration Database

Preoperative Right Heart Dysfunction and Gastrointestinal Bleeding in Patients with Left Ventricular Assist Devices. ASAIO J 2021 Mar 01;67(3):324-331

Date

02/26/2021

Pubmed ID

33627608

DOI

10.1097/MAT.0000000000001224

Scopus ID

2-s2.0-85102096001 (requires institutional sign-in at Scopus site)   7 Citations

Abstract

Gastrointestinal bleeding (GIB) is a common cause of morbidity among patients supported by left ventricular assist devices (LVADs). The aim of this study was to identify if pre-LVAD right ventricular (RV) dysfunction is associated with risk of GIB after LVAD implantation. Of 398 patients implanted with LVADs between July 2008 and July 2016, 130 (33%) developed GIB at a median of 2.6 months following LVAD implantation. Arteriovenous malformations (AVMs) were found in 42 (34%) GIB patients. Patients with GIB were older and more likely to have hypertension, diabetes, and ischemic cardiomyopathy. On pre-LVAD echocardiography, GIB patients had increased RV diastolic dimension (4.7 ± 0.8 vs. 4.4 ± 0.9 cm, p = 0.02), a higher rate of greater than mild tricuspid valve (TV) regurgitation (73 [60%] vs. 120 [47%], p = 0.006), and underwent TV repair more often (38 [30%] vs. 43 [16%], p = 0.0006) during LVAD implantation. After multivariable adjustment, preoperative greater than mild RV enlargement (hazard ratio [HR] 2.32, 95% CI 1.12-5.03; p = 0.03), TV regurgitation (HR 1.83, CI 1.02-3.44; p = 0.01), and TV repair (HR 3.76, confidence interval [CI] 1.02-4.44; p = 0.01) remained associated with risk of GIB. This finding was driven by the AVM-GIB subgroup. Preoperative RV enlargement and TV regurgitation are associated with post-LVAD AVM-related GIB.

Author List

Liebo M, Newman J, Yu M, Hussain Z, Malik S, Lowes B, Joyce C, Zolty R, Basha HI, Heroux A, McGee E Jr, Um JY, Raichlin E

Author

Eugenia Raichlin MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Arteriovenous Malformations
Female
Gastrointestinal Hemorrhage
Heart Failure
Heart-Assist Devices
Humans
Incidence
Male
Middle Aged
Retrospective Studies
Risk Factors
Ventricular Dysfunction, Right