Case study
Safety of conventional and wireless capsule endoscopy in patients supported with nonpulsatile axial flow Heart-Mate II left ventricular assist device

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Background

Left ventricular assist devices (LVADs) are increasingly being used as a bridge for cardiac transplantation in patients with decompensated cardiac function. A known complication of these devices is severe and sometimes life-threatening GI bleeding, usually related to the presence of angioectasias. Endoscopy has been generally accepted as safe in patients with cardiac disease and implanted cardiac devices, when it is performed with appropriate monitoring. However, the literature is sparse regarding the safety of endoscopy in patients with LVADs.

Objective

Given the potential risks for GI bleeding in this subgroup of patients, our aim was to shed light on the potential safety of endoscopy in these patients.

Design

We present our experience with endoscopic intervention for varied sources of GI bleeding in a group of patients with the HeartMate II implantable LVAD.

Setting

A tertiary care university-based hospital setting, Tampa General Hospital at the University of South Florida, Tampa, Florida.

Patients

Patients with severe cardiomyopathy requiring cardiac support with the HeartMate II implantable LVAD.

Interventions

Patients received upper and lower GI endoscopy as dictated by their clinical presentations. One patient received capsule endoscopy as well.

Conclusions

We observed that endoscopy, including capsule endoscopy, may be safely performed in these patients with appropriate monitoring.

Section snippets

Presentation, history, intervention

A 77-year-old man with a history of ischemic cardiomyopathy and decompensated heart failure, requiring hemodynamic support with a HeartMate II left ventricular assist device, was admitted with melena of several weeks' duration. Hemoglobin level was 8.0 g/dL (normal 14-16 g/dL) and the international normalized ratio was 2.0. He had a remote history of a large anterior wall myocardial infarction requiring subsequent coronary artery bypass grafting. One year before this admission the patient was

Discussion

Mechanical support with an implantable ventricular assist device is routinely used in patients with decompensated cardiac disease in need of temporary circulatory support while awaiting cardiac transplantation. LVADs were initially approved by the Food and Drug Administration for bridging therapy before cardiac transplantation.4 More recently, LVAD use has been shown to improve long-term survival in patients with intractable heart failure who are not candidates for cardiac transplantation.5

The

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