Significant Restrictive or Obstructive Lung Diseases are Associated with an Increased Risk of Gastrointestinal Bleeding in Patients on Left Ventricular Assist Device Support

PURPOSE: Despite the recent advances in Left Ventricular Assist Device (LVAD) therapy, gastrointestinal bleeding (GIB) remains a frequent and severe complication. A growing body of evidence suggests that the combination of hypoperfusion and hypoxia in the microcirculation may activate the angiogenesis cascade and promote the formation of arteriovenous malformations. We hypothesized that LVAD patients with concomitant significant restrictive or obstructive lung diseases may have an increased risk of GIB due to their chronic hypoxemic state. METHODS: We retrospectively identified 99 patients on HeartMate II LVAD support (age 54±13 y, 77% male, 36% ischemic etiology) who had a pulmonary function test (PFT) performed. Significant lung disease was defined as a moderate or severe obstructive/restrictive pattern detected during PFT and the concomitant use of inhaler therapy. GIB was defined as clinical evidence of GI bleeding and a decrease in hemoglobin of at least 1 g/dL. RESULTS: 11 patients (11%) had significant lung disease and 27 patients (27%) experienced a GIB. The risk of GIB was increased in patients with significant lung diseases (Hazard Ratio 2.59, 95% confidence interval 1.038 to 6.452). Freedom from GIB was significantly higher in patients without significant lung disease in Kaplan-Meier analysis (Figure). CONCLUSION: Significant obstructive or restrictive lung diseases were associated with an increase in the risk of GIB. Further studies on the association of tissue hypoxia and activation of the angiogenesis cascade/bleeding diathesis in LVAD patients are warranted.