Predictive Risk Factors for Postoperative Gastrointestinal Bleeding in Patients Receiving Left Ventricular Assist Devices: 2027

Purpose: Left ventricular assist devices (LVAD) have emerged as an effective way to provide hemodynamic support for patients with advanced heart failure. These devices can be used as a bridge to heart transplantation and also as end stage therapy for those ineligible for transplant. However, these devices increase the risk of gastrointestinal bleeding (GIB); perhaps from a loss of Von Willebrand factor multimers. Presently, there are no formal preoperative guidelines to assess the risk of bleeding in patients receiving ventricular assist devices. Our aim is to identify factors in the preoperative assessment that will allow us to predict a patient's risk for postoperative GI bleeding. Methods: We employed a retrospective analysis in patients who underwent LVAD implantation at a tertiary care medical center. Medical records were reviewed and data collected on patient age, gender, type of LVAD, etiology of heart failure, comorbidities, echocardiographic measurements, hemodynamics of right heart catheterization, prior history of GI bleeding, and various pre-LVAD lab results that have been shown to be associated with perioperative mortality. Weighted prediction model was used for risk scoring, with multiple independent variables and a dependent variable scaled from 0 to 1 (percent risk of bleeding). Results: Total of 20 patients (mean age 59.8 years, range 42-75 years; 75% men, 25% women). 40% had postoperative GIB defined as the presence of hematochezia or melena with at least a drop in hemoglobin of >2 gm/dl. On univariate analysis, preoperative BUN (p=0.004) and ejection fraction (p=0.005) were found to be statistically significant. In the multivariate regression model, only two variables reached/approached statistical significance: gender (p=0.048) and left ventricular inner dimension (p=0.065). However, the overall model failed to reach statistical significance (p=0.26). Conclusion: Gastrointestinal bleeding occurs in a significant number of patients after LVAD implantation; however, our model was unable to identify predictive risk factors. With the addition of supplementary patient and outcomes data, the creation of a mathematical formula to predict bleeding risk promises to be both feasible and attainable.Figure: P-values.