Karra, Ravi

Introduction: Gastrointestinal bleeding (GIB) after continuous-flow left ventricular assist device (CF-LVAD) implantation is common, with an incidence estimated at 18-40% per year. While the pathophysiology of GIB in these patients is unclear, physiologic changes related to the absence of pulsatility may account for the high rates of GIB seen in these patients. Hypothesis: Improved left ventricular (LV) function (increased myocardial pulsatility) after LVAD implantation may be associated with decreased rates of GIB. Methods: We studied 119 consecutive patients with CF-LVADs implanted between March 2006-November 2016 who received serial transthoracic echocardiograms (TTE), including at least one pre-implant and one post-implant TTE. Left ventricular ejection fraction (LVEF) was assessed by experienced readers, with a kappa statistic between readers >0.90. Improved LV function was defined as an improvement of at least 7% between the pre-implant LVEF and the best post-implant LVEF obtained with 9 months of the implantation date. Similarly, worsening LV function was defined as a decrease of at least 7%. Primary GIB was defined using INTERMACS adverse event criteria. Patients were followed until transplantation, device complication requiring explantation, or death. Results: The study sample was 58±12 years old, 72% male, and 63% Caucasian. Hemoglobin at implantation was 11±2 g/dL. Maximum LV recovery was seen a median of 103 (IQR 49-158) days after LVAD implantation. Improved LV function occurred in 25 (21%) patients, while LVEF remained stable or worsened in 94 (79%) of patients. When compared with patients whose LVEF remained stable or worsened, patients with improved LV function were more likely to be female (p=0.05). GIB occurred in 29 patients (24%). Improved LV function was associated with a significantly decreased risk of GIB (Figure; p=0.05). Conclusions: Improved LV function is seen in one-fourth of patients and is associated with a significantly decreased risk of GIB following CF-LVAD implantation.