Key result
Gastrointestinal bleeding in transplant-eligible patients with a continuous-flow left ventricular assist device was associated with a 27% lower rate of cardiac transplantation.
Why the study?
Does gastrointestinal bleeding reduce rates of cardiac transplantation in patients with continuous-flow left ventricular assist devices?
Cohort (n=232)
No
Does gastrointestinal bleeding reduce rates of cardiac transplantation in patients with continuous-flow left ventricular assist devices?
Gastrointestinal bleeding in patients with continuous-flow LVADs is associated with a significantly lower rate of subsequent cardiac transplantation, despite similar survival rates.
Answers are grounded in this paper and cite their sources.
Highlights GI bleeding as potential transplant barrier in LVAD patients; hypothesis-generating for prevention trials before practice change.
Gastrointestinal bleeding (GIB) remains a significant problem after continuous-flow left ventricular assist device (CF-LVAD) implantation. We hypothesized that the subsequent need for blood transfusions in patients with GIB may reduce rates of cardiac transplantation. We performed a retrospective review of 232 patients implanted with the HeartMate II (HM II) CF-LVAD from June 2005 through May 2013 at our center to determine risk factors for GIB and assess its effect on cardiac transplantation. Over a total LVAD follow-up time of 364 person-years, 62 GIB episodes occurred in 49 patients (27%), for an event rate of 0.45 gastrointestinal bleeds/patient-year of LVAD support. Women made up 15% of our cohort, yet contributed 29% of the GIB (p = 0.06). Survival at 6 month, 1 year, and 2 years was not statistically different in patients who developed GIB and those who did not (77% vs 78%, 74% vs 71%, and 61% vs 54%, respectively). In transplant-eligible patients, GIB was associated with a 27% lower rate of cardiac transplantation (rate ratio 0.73, p < 0.05). Although the mechanism behind this finding is unclear, GIB appears to be linked to higher transfusion rates, which may cause the development of subsequent allosensitization.
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Holley et al. (2015) conducted a cohort in Continuous-flow left ventricular assist device (CF-LVAD) support (n=232). Gastrointestinal bleeding vs. No gastrointestinal bleeding was evaluated on Cardiac transplantation (rate ratio 0.73, p=< 0.05). Gastrointestinal bleeding in transplant-eligible patients with a continuous-flow left ventricular assist device was associated with a 27% lower rate of cardiac transplantation.
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