Editorial
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2017; 23(22): 3945-3953
Published online Jun 14, 2017. doi: 10.3748/wjg.v23.i22.3945
Bleeding with the artificial heart: Gastrointestinal hemorrhage in CF-LVAD patients
Grigoriy E Gurvits, Elena Fradkov
Grigoriy E Gurvits, Division of Gastroenterology, New York University School of Medicine/Langone Medical Center, New York, NY 10016, United States
Elena Fradkov, Department of Medicine, New York University School of Medicine/Langone Medical Center, New York, NY 10016, United States
Author contributions: Gurvits GE and Fradkov E equally contributed to this manuscript.
Conflict-of-interest statement: The authors have no conflict of interest related to the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Grigoriy E Gurvits, MD, Division of Gastroenterology, New York University School of Medicine/Langone Medical Center, 530 First Avenue, SKI-9N, New York, NY 10016, United States. grigoriy.gurvits@nyumc.org
Telephone: +1-212-2633095 Fax: +1-212-2633095
Received: February 8, 2017
Peer-review started: February 9, 2017
First decision: March 30, 2017
Revised: April 10, 2017
Accepted: May 9, 2017
Article in press: May 9, 2017
Published online: June 14, 2017
Abstract

Continuous-flow left ventricular assist devices (CF-LVADs) have significantly improved outcomes for patients with end-stage heart failure when used as a bridge to cardiac transplantation or, more recently, as destination therapy. However, its implantations carries a risk of complications including infection, device malfunction, arrhythmias, right ventricular failure, thromboembolic disease, postoperative and nonsurgical bleeding. A significant number of left ventricular assist devices (LVAD) recipients may experience recurrent gastrointestinal hemorrhage, mainly due to combination of antiplatelet and vitamin K antagonist therapy, activation of fibrinolytic pathway, acquired von Willebrand factor deficiency, and tendency to develop small intestinal angiodysplasias due to increased rotary speed of the pump. Gastrointestinal bleeding in LVAD patients remains a source of increased morbidity including the need for blood transfusions, extended hospital stays, multiple readmissions, and overall mortality. Management of gastrointestinal bleeding in LVAD patients involves multidisciplinary approach in stabilizing the patients, addressing risk factors and performing structured endoluminal evaluation with focus on upper gastrointestinal tract including jejunum to find and eradicate culprit lesion. Medical and procedural intervention is largely successful and universal bleeding cessation occurs in transplanted patients.

Keywords: Gastrointestinal bleeding, Left ventricular assist devices, Heart failure, Angioectasia, Endoscopy

Core tip: Classic descriptors and latest developments in care of left ventricular assist devices (LVAD) patients presenting with gastrointestinal (GI) hemorrhage. Pathophysiology, etiology, clinical presentation, risk factors, location within the GI tract, differential diagnosis, management, complications, and prognosis of LVAD patients with GI hemorrhage. Comprehensive review of aspects of clinical care and future research in this patient population.