Peripheral Vein Saturation May be Used as a Surrogate Marker for Increased Susceptibility to Gastrointestinal Bleeding in LVAD Patients

Yaron D. Barac 1 Victor Rubchevsky 1 Tuvia Ben- Gal 2 Ram Sharony 1 Daniel Murninkas 2 Miriam Abuhazira 1 Dimitry Golubov 1 Victoria Yaari 2 Tal Hasin 2 Ben Ben-Avraham 2 Benjamin Medalion 1 Eitan Snir 1 Ran Kornowski 2 Dan Aravot 1
1The Cardiothoracic Department, Rabin Medical Center, Petach Tikva
2The Cardiology Department, Rabin Medical Center, Petach Tikva

Background: Left ventricular assist devices (LVAD) are effective therapeutic options for end-stage HF patients. Contemporary continuous-flow LVADs are associated with increased occurrence of gastrointestinal (GI) bleeding events secondary to arteriovenous malformations (AVMs), Most occur in the 1st year and cause major morbidity.

Hypothesis: Although the association between AVM and LVAD was observed, the mechanism behind this association is not clear yet. We hypothesized that: LVAD induced AVM in the GI is accompanied by peripheral AV shunts and that peripheral venous O2 saturation may become an important tool in the regular assessment of LVAD patients.

Methods: We have measured peripheral vein O2 saturation in LVAD patients during their routine clinic visits. The patients were divided into two groups; the first during the first year post LVAD implantation and the second thereafter.

Results: Our cohort included 19 patients: Average O2 saturation level was significantly different between the two groups; 43.7% in group 2 (more than one year of LVAD support), and 69.1% in-group 1 (less than one year of LVAD support) (P<0.05). Moreover, the average O2 saturation in the patients that had a GI bleeding, at any given time from both groups was 57%.

Conclusion: This is the first observation that continuous flow LVAD implantation is related to increased peripheral vein O2 saturation suggesting that continuous flow LVADs induce the formation of peripheral AV shunts. Our observation suggests that this phenomenon decays as time passes from the implantation day. This correlation between simple peripheral vein O2 saturation measurements and the increased susceptibility to GI bleeding may be used in the future (following further validation) as a tool to assess LVAD patients at risk for GI bleeding and potentially prevent such an event by manipulating the management of the LVAD implanted patients with the intention to increase pulsatility.









Powered by Eventact EMS