Gastrointestinal Bleeding During Index Hospitalization for Mechanical Circulatory Support Devices Implantation: Is the Squeeze Worth the Ooze?

Excerpt

Mechanical circulatory support devices, which include left ventricular assist devices (LVADs) and intra-aortic balloon pumps (IABPs), have been used increasingly over the past decade. LVADs sustain patients with severe left ventricular dysfunction who are being evaluated for or await cardiac transplantation, as a destination therapy, or a bridge to recovery of cardiac function [1]. Their increasing popularity in the past decade is partially attributable to remarkable advances in LVAD technology. First-generation devices, which functioned by a mechanism of pulsatile blood flow, were beset by poor durability and high rates of infection and thrombosis, encouraging the development of smaller, continuous-flow LVADs which involve rotary-pump technology to provide blood flow with reduced pulsatility. These latter devices have improved the probability of survival free from stroke and device failure at 2 years compared with the first-generation device [2]. Nevertheless, the increasing use of this technology has been accompanied by a notable rate of gastrointestinal bleeding (GIB) with a recent meta-analysis estimating the pooled prevalence of GIB in LVAD patients to be an astounding 23% [3]. …