Nakajima-Doi Seiko, Seguchi Osamu, Shintani Yasuhiro, Fujita Tomoyuki, Fukushima Satsuki, Matsumoto Yorihiko, Eura Yuka, Kokame Koichi, Miyata Shigeki, Matsuda Sachi, Mochizuki Hiroki, Iwasaki Keiichiro, Kimura Yuki, Toda Koichi, Kumai Yuto, Kuroda Kensuke, Watanabe Takuya, Yanase Masanobu, Kobayashi Junjiro, Fukushima Norihide
Department of Transplant Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe Shin-machi, Suita, 564-8565, Osaka, Japan.
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
J Artif Organs. 2019 Dec;22(4):334-337. doi: 10.1007/s10047-019-01121-7. Epub 2019 Jul 23.
Gastrointestinal bleeding (GIB) is among the major complications affecting implantable continuous-flow left ventricular assist device (iLVAD) recipients and is the major cause of re-hospitalization. GIB in iLVAD recipients is sometimes critical, and controlling bleeding using conventional approaches is difficult. A 35-year-old woman developed refractory GIB from multiple gastric polyps and de novo angiodysplasia after Jarvik2000 iLVAD implantation. Discontinuation of anticoagulation and antiplatelet therapies had little effect on GIB; thus, multiple endoscopic hemostatic therapies were performed. However, bleeding recurred several times, and red blood cell (RBC) transfusion in large volumes was required for progressive anemia. Furthermore, the von Willebrand factor (VWF) multimer analysis revealed loss of the high-molecular weight multimer, which may have resulted from the high-speed rotation of the axial-flow LVAD pump. To supplement VWF, cryoprecipitate was administered, but it was effective for only several days. Finally, the patient was treated with octreotide, a somatostatin analog, on post-operative day 58. After starting octreotide, tarry stool gradually decreased, and progression of anemia slowed down within the first 14 days of treatment; thus, the total RBC transfusion volume was reduced without additional hemostatic interventions, including cryoprecipitate administration. The patient developed mediastinitis on post-operative day 68 and died of sepsis on post-operative day 72. There was no adverse effect associated with octreotide use. Although the observation period was short, octreotide appears to be useful for resolving recurrent GIB after iLVAD implantation and reducing blood transfusions.
胃肠道出血（GIB）是影响植入式连续流左心室辅助装置（iLVAD）接受者的主要并发症之一，也是再次住院的主要原因。iLVAD接受者的GIB有时很严重，使用传统方法控制出血很困难。一名35岁女性在植入Jarvik2000 iLVAD后，因多发胃息肉和新生血管发育异常出现难治性GIB。停用抗凝和抗血小板治疗对GIB几乎没有效果；因此，进行了多次内镜止血治疗。然而，出血多次复发，因进行性贫血需要大量输注红细胞（RBC）。此外，血管性血友病因子（VWF）多聚体分析显示高分子量多聚体缺失，这可能是由于轴流左心室辅助装置泵的高速旋转所致。为补充VWF，给予了冷沉淀，但仅有效几天。最后，患者在术后第58天接受了生长抑素类似物奥曲肽治疗。开始使用奥曲肽后，柏油样便逐渐减少，在治疗的前14天内贫血进展减缓；因此，在未进行包括给予冷沉淀在内的额外止血干预的情况下，RBC输注总量减少。患者在术后第68天发生纵隔炎，并于术后第72天死于败血症。使用奥曲肽未出现不良反应。尽管观察期较短，但奥曲肽似乎有助于解决iLVAD植入术后复发性GIB并减少输血。
