Retrospective determination of risk factors for gastrointestinal system bleeding occurring in end-stage heart failure patients received continuous flow ventricular assist device

PURPOSE: It was aimed to retrospectively investigate the risk factors of gastrointestinal bleeding(GIB) in patients with end-stage heart failure who were implanted with a continuous flow ventricular assist device. PATIENTS AND METHODS: 90 patients who were implanted with a continuous flow VAD at the Ege University Cardiovascular Surgery Department between 2010 and 2012, due to end-stage heart failure were included in this study. The data of the patients were examined retrospectively, and ethical approval was obtained from the Ege University Ethics Committee before the study. GIB was observed in 15 of 90 patients implanted with VAD. 11 (73%) of these patients were male and 4 (27%) were female. vWF level, platelet counts, postoperative aortic valve opening, postoperative right ventricular failure and support duration were investigated as risk factors for preoperative and postoperative risk factors in patients. RESULTS: Etiological distribution, DM rate, HT rate, HL rate, CKD rate, CVE rate did not differ significantly (p ˃ 0.05) in the groups with and without postoperative GIB. In the group with postoperative GIB, postoperative 3rd month, postoperative 6th month and last measurement vWF values showed a significant decrease (p ˂ 0.05) compared to the preoperative period. In addition, the rate of patients with low vWF in the postoperative 3rd month in the group with postoperative GIB was significantly (p ˂ 0.05) higher than the group without postoperative GIB bleeding. RV failure was observed in 4 of 15 patients with postoperative GIB. The rate of postoperative RV failure was found to be significantly (p ˂ 0.05) higher than the group without postoperative GI bleeding. The presence/absence of aortic valve opening was not found to be statistically significant in the groups with and without postoperative GIC (p ˃ 0.05). The duration of support in the groups with and without GI bleeding was not found to be significant (p ˃ 0.05). Although it showed a decreasing trend in line with the measurements made during the follow-up period, platelet counts did not pose a statistical risk (p ˃ 0.05). CONCLUSION: GIB seen in continuous flow VAD patients is a serious life-threatening complication. Risk factors are still being investigated. In our study, it was determined that acquired vWF Syndrome was the most effective parameter in this regard, but not the only factor. KEYWORDS: Ventricular assist device, continuous flow, gastrointestinal bleeding, von Willebrand Syndrome, right ventricular failure