Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio.
Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio.
Clin Gastroenterol Hepatol. 2015 Jan;13(1):107-14.e1. doi: 10.1016/j.cgh.2014.05.012. Epub 2014 May 21.
BACKGROUND & AIMS: Ventricular assist devices (VADs) are used to treat patients with end-stage heart disease. However, patients with VADs frequently develop gastrointestinal (GI) bleeding. We investigated the incidence, etiology, and outcome of GI bleeding in patients with VADs.
In a retrospective study, we analyzed data from 391 consecutive patients (mean age, 53.9 ± 14.2 years; 81% male) who underwent VAD implantation for end-stage heart disease from January 2000 through May 2012 at the Cleveland Clinic. Multivariable logistic regression analysis was used to identify factors independently associated with GI bleeding in patients with VADs.
Sixty-two patients (15.9%) had GI bleeding. The risk of GI bleeding increased by 10% for every 5-year increase in age (P = .006). GI bleeding was also associated with lower body mass index (P = .046), current smoking (P = .007), and lower baseline levels of hemoglobin (P < .001). Bleeding was primarily overt (79%), and most patients presented with hematochezia (43.5%). Causes of bleeding were primarily vascular malformations (26.5%) and ulcers (26.5%). Patients who received VADs as their only therapy, rather than as a bridge-to-transplantation, were more likely to have GI bleeding (P = .008). Colonoscopy detected GI bleeding with the highest diagnostic yield; most bleeding was associated with colonic lesions (51.4%). Overall mortality was 39.4%, and 2 deaths were directly related to GI bleeding.
On the basis of a large case series analysis, GI bleeding is common after implantation of VADs (15.9% of patients have at least 1 episode of bleeding). Episodes were mostly overt and predominantly from the lower GI tract; colonoscopy is the best method of detection.
心室辅助装置（VAD）用于治疗终末期心脏病患者。然而，VAD 患者常发生胃肠道（GI）出血。我们研究了 VAD 患者 GI 出血的发生率、病因和结局。
在一项回顾性研究中，我们分析了 2000 年 1 月至 2012 年 5 月克利夫兰诊所连续 391 例因终末期心脏病行 VAD 植入术患者的数据（平均年龄 53.9 ± 14.2 岁，81%为男性）。采用多变量 logistic 回归分析确定与 VAD 患者 GI 出血相关的独立因素。
62 例（15.9%）患者发生 GI 出血。年龄每增加 5 岁，GI 出血风险增加 10%（P =.006）。GI 出血还与较低的体重指数（P =.046）、当前吸烟（P =.007）和较低的基线血红蛋白水平相关（P <.001）。出血主要为显性（79%），大多数患者表现为血便（43.5%）。出血的主要原因是血管畸形（26.5%）和溃疡（26.5%）。仅接受 VAD 治疗而不是作为移植桥接的患者更易发生 GI 出血（P =.008）。结肠镜检查对 GI 出血的诊断率最高；大多数出血与结肠病变有关（51.4%）。总死亡率为 39.4%，有 2 例死亡与 GI 出血直接相关。
基于大型病例系列分析，VAD 植入后 GI 出血很常见（15.9%的患者至少有 1 次出血发作）。发作大多为显性，主要来自下消化道；结肠镜检查是最好的检测方法。
