Case reports
Gastrointestinal bleeding from arteriovenous malformations in patients supported by the Jarvik 2000 axial-flow left ventricular assist device

https://doi.org/10.1016/j.healun.2003.10.018Get rights and content

Abstract

The long-term effects of axial-flow mechanical circulatory support in humans are unclear. We report 3 cases of chronic gastrointestinal bleeding after implantation of a Jarvik 2000 axial-flow left ventricular assist device. The bleeding was refractory to aggressive management and in 2 cases resolved only after orthotopic cardiac transplantation.

Section snippets

Jarvik 2000 left ventricular assist device

The Jarvik 2000 is an electrically powered, axial-flow LVAD. The pump is small, about the size of a D-cell battery, and is placed within the left ventricle. Its outflow graft extends from the left ventricular apex to the descending thoracic aorta. A power cable containing electric wires leads from the pump through the chest wall to the right upper quadrant of the abdomen, where the cable is externalized and connected to an analog controller. The pump is powered by lithium ion or lead acid

Presentation, history, and treatment

A 60-year-old man with a history of coronary artery disease, coronary artery bypass surgery in 1985, and implantation of an automatic internal cardiac defibrillator in 1998 presented with chest pain. On admission, he was found to have renal insufficiency and pulmonary edema. He had no history of GI bleeding. Catheterization revealed ischemic cardiomyopathy, and he was placed on the cardiac transplantation waiting list. Despite treatment with continuous intravenous inotropes and diuretics, the

Discussion

Mechanical circulatory support with an implantable ventricular assist device is applied routinely in patients needing temporary circulatory assistance while awaiting cardiac transplantation.4, 5, 6 Less frequently, a ventricular assist device is used to support patients with acute heart failure until myocardial function improves7 or to provide permanent support to patients who have end-stage heart failure, are not candidates for heart transplantation, and have no hope for improvement in

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