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首页> 外文期刊>Journal of cardiac surgery. >Increased incidence of gastrointestinal bleeding following implantation of the heartmate II LVAD
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Increased incidence of gastrointestinal bleeding following implantation of the heartmate II LVAD

机译：心伴侣II LVAD植入后胃肠道出血的发生率增加

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Background: The HeartMate II (HMII) Left Ventricular Assist System (Thoratec Corporation, Pleasanton, CA, USA), an axial continuous-flow left ventricular assist device (LVAD), has been approved for use in bridge-to-transplant patients and is under investigation for destination therapy. To avoid device-related thromboembolic complications, antiplatelet, and anticoagulation therapy are routinely administered. A worrisome frequency of gastrointestinal (GI) bleeding events has been observed. Methods: A retrospective review of all 33 patients undergoing long-term LVAD implantation between June 1, 2006 and July 31, 2008 at our institution for any indication was conducted. Anticoagulation consisted of heparin (intravenous or subcutaneous) followed by transition to Coumadin therapy to a target INR of two to three. Antiplatelet therapy consisted of low-dose aspirin and dipyridamole. Results: Twenty patients received the HMII and 13 patients received other devices. Eight (40%) HMII recipients suffered at least one episode of GI bleeding while no GI bleeding occurred in recipients of other devices (p = 0.012). Of 17 total bleeding episodes, no definitive source could be identified in 11 instances (65%). Conclusions: Although definitive source identification remains elusive, we believe that the majority of bleeding arises in the small bowel, possibly due to angiodysplasias, similar to the pathophysiology encountered in patients with aortic stenosis and GI bleeding. As we move toward wider use of the HMII and other axial continuous-flow devices in both bridge-to-transplant patients and for destination therapy, more studies will be necessary to understand the mechanisms of this obscure GI bleeding and develop treatment strategies to minimize its development.
机译：背景：HeartMate II（HMII）左心室辅助系统（Thoratec Corporation，美国加利福尼亚州普莱森顿）是一种轴向连续流左心室辅助设备（LVAD），已被批准用于桥对移植患者，并且正在接受目的地疗法的调查。为了避免与器械相关的血栓栓塞并发症，应常规进行抗血小板和抗凝治疗。胃肠道（GI）出血事件的频率令人担忧。方法：回顾性分析2006年6月1日至2008年7月31日在我院接受长期LVAD植入术的所有33例患者的任何适应症。抗凝药物由肝素（静脉内或皮下）组成，然后过渡到香豆素治疗，目标INR为2-3。抗血小板治疗包括小剂量阿司匹林和双嘧达莫。结果：20例患者接受了HMII，13例患者接受了其他器械。八名（40％）HMII接受者经历了至少一次胃肠道出血发作，而其他装置的接受者中没有发生胃肠道出血（p = 0.012）。在17例总出血事件中，有11例（65％）无法确定确切来源。结论：尽管仍无法确定确切的来源，但我们认为大部分出血发生在小肠，可能是由于血管增生所致，类似于主动脉瓣狭窄和胃肠道出血患者的病理生理。随着我们朝着跨桥移植患者和目的地治疗中更广泛地使用HMII和其他轴向连续流装置的方向发展，有必要进行更多的研究来了解这种模糊的胃肠道出血的机制并制定治疗策略以最大程度地减少其发展。

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