Journal of Cardiac Failure

Gastrointestinal bleeding from arteriovenous malformations in recipients of left ventricular assist devices


Background: Arteriovenous malformations (AVMs) are abnormal blood vessels in the gastrointestinal (GI) tract and are a common source of bleeding. They can develop through venous obstruction or hypoperfusion, and may be associated with aortic stenosis or renal insufficiency. It has been suggested that nonpulsatile left ventricular assist devices (LVADs) may contribute to AVMs due to the lower pulse pressure generated by these devices, similar to aortic stenosis.
Methods: We performed a retrospective analysis of 52 consecutive LVAD recipients. Nonpulsatile devices included VentrAssist, HeartMate II, and Jarvik 2000. Pulsatile devices included Novacor and HeartMate XVE. The primary endpoint was GI bleeding that was clinically evident by hematemesis, melena, guaiac positive stool, or iron deficiency anemia, and confirmed by endoscopy.
Results: Only age was found to be an independent predictor of GI bleeding (p = 0.001). Ten subjects received pre-implant colonoscopies. Seven had pathologic findings (4 polyps, 2 diverticulosis, 1 colitis), 3 of whom went on to develop post-implant GI bleeding (p = 1.000).
Conclusions: Nonpulsatile LVADs were not associated with an increase in AVMs or GI bleeding. The limited number of pre-implant colonoscopies was not predictive of post-implant GI bleeding.




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