Key result
Prophylactic hemorrhoidal artery ligation prior to LVAD implantation prevented recurrent gastrointestinal bleeding in one patient, whereas post-implantation treatment in another patient resulted in fatal complications.
Why the study?
Does hemorrhoidal artery ligation prevent gastrointestinal bleeding in patients with Stage D heart failure undergoing LVAD implantation?
Case Report (n=2)
Does hemorrhoidal artery ligation prevent gastrointestinal bleeding in patients with Stage D heart failure undergoing LVAD implantation?
Screening for and managing hemorrhoids prior to LVAD implantation in patients with advanced heart failure may reduce the risk of severe post-operative gastrointestinal bleeding.
Caution advised for post-LVAD hemorrhoidal artery ligation; leaves open the role of prophylactic intervention.
Continuous-flow left ventricle assist devices (CF-LVADs) has become an essential modality in the management of stage D heart failure (HF) with significant improvement in survival and quality of life. Due to the durability of such devices and long term support complications such as bleeding and aortic insufficiency has emerged. Bleeding accounts for more than 20 % with the majority being from the gastrointestinal tract. The increase of bleeding tendency are mainly attributed to the loss of large von Willebrand's Factor (vWF) multimers due to shear stress with the chronic intake of anticoagulants. We are reporting two cases of patients with Stage D HF and history of hemorrhoids presenting for LVAD implantation. Many efforts that decrease bleeding related to CF-LVADs will be discussed with focus on hemorrhoids.
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Skouri et al. (2016) conducted a case report in Stage D heart failure with history of hemorrhoids (n=2). Hemorrhoidal artery ligation (HAL) was evaluated. Prophylactic hemorrhoidal artery ligation prior to LVAD implantation prevented recurrent gastrointestinal bleeding in one patient, whereas post-implantation treatment in another patient resulted in fatal complications.
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