Gastrointestinal Bleeding Following Left Ventricular Assist Device (LVAD) Implantation: Taking the Pulse of the Problem

Excerpt

Over the course of the last decade, implantation of left ventricular assist devices (LVADs) has become an increasingly popular treatment strategy for patients with advanced heart failure, both as a bridge to heart transplantation and as a “destination” therapy. The first generation of LVADs, based on a pulsatile mechanism, was plagued by poor reliability and high infection and thrombosis rates, leading to the development of smaller and more reliable continuous-flow (CF) LVADs. Following the introduction of CF-LVADs, postimplantation survival rates improved to as high as 50–75 % at 2 years [1]. Not surprisingly, CF-LVAD implantation rates have grown exponentially. With the rapidly expanding use of LVADs, it has become clear that long-term mechanical circulatory support is associated with gastrointestinal (GI) bleeding, now considered one of the more common and recalcitrant long-term complications following LVAD implantation, with a recent meta-analysis reporting the prevalence of GI bleeding near 30 % [2]. …