Muthiah Kavitha, Robson Desiree, Macdonald Peter S, Keogh Anne M, Kotlyar Eugene, Granger Emily, Dhital Kumud, Spratt Phillip, Hayward Christopher S
Heart Failure and Transplant Unit, St Vincent's Hospital Sydney, Sydney, Australia.
Int J Artif Organs. 2013 Jul;36(7):449-54. doi: 10.5301/ijao.5000224. Epub 2013 May 20.
Continuous flow left ventricular assist devices (cfLVADs) are used in clinical practice for the management of end-stage heart failure. Axial flow cfLVADS have been associated with increased rates of adverse gastrointestinal events such as bleeding angiodysplasia. The purpose of this study was to determine the incidence of bleeding gastrointestinal tract angiodysplasia and the profile of patients supported with the centrifugal cfLVAD, referred for endoscopy.
A retrospective analysis of 66 patients implanted with Ventrassist (n = 33) and Heartware (n = 33) centrifugal continuous flow LVADs was performed. All patients were on warfarin, aspirin and/or clopidogrel. Endoscopy was performed in all patients with either active gastrointestinal bleeding (n = 6) or anemia with positive fecal occult blood (n = 6).
Bleeding gastrointestinal angiodysplasia was demonstrated in 5 out of the 12 (41.6%) patients who underwent endoscopy from the cohort of 66 cfLVAD supported patients (7.6%). The incidence of bleeding angiodysplasia was higher than the age-standardized rate of andiodysplasia from literature (0.8%). Active gastrointestinal bleeding in one other patient was due to diverticulosis. The five patients with bleeding angiodysplasia tended to be older than the remaining 61 patients (58.8 ± 10.3 vs 49.6 ± 15.7 years, p = 0.2).
We found excess bleeding angiodysplasia in patients on centrifugal cfLVAD support. It may be appropriate to screen for angiodysplasia particularly in older patients prior to support by centrifugal cf LVADs. Reasons for the higher rate of bleeding angiodysplasia in cfLVAD patients warrant further study.
连续流左心室辅助装置（cfLVADs）在临床实践中用于终末期心力衰竭的治疗。轴流cfLVADS与诸如出血性血管发育异常等不良胃肠道事件发生率增加有关。本研究的目的是确定出血性胃肠道血管发育异常的发生率以及接受离心式cfLVAD支持并接受内镜检查的患者特征。
对66例植入Ventrassist（n = 33）和Heartware（n = 33）离心式连续流左心室辅助装置的患者进行回顾性分析。所有患者均服用华法林、阿司匹林和/或氯吡格雷。对所有有活动性胃肠道出血（n = 6）或粪便潜血阳性的贫血患者（n = 6）进行内镜检查。
在66例接受cfLVAD支持的患者队列中，12例接受内镜检查的患者中有5例（41.6%）出现出血性胃肠道血管发育异常（7.6%）。出血性血管发育异常的发生率高于文献报道的年龄标准化血管发育异常发生率（0.8%）。另一例患者的活动性胃肠道出血是由憩室病引起的。5例有出血性血管发育异常的患者往往比其余61例患者年龄更大（58.8±10.3岁对49.6±15.7岁，p = 0.2）。
我们发现接受离心式cfLVAD支持的患者中出血性血管发育异常过多。在接受离心式cfLVAD支持之前，特别是对老年患者筛查血管发育异常可能是合适的。cfLVAD患者出血性血管发育异常发生率较高的原因值得进一步研究。
