Gastrointestinal Bleeding Following Left Ventricular Assist Device (LVAD) Implantation: A Case Report and Literature Review

Introduction: Left ventricular assist devices (LVADs) have become increasingly prevalent as a life-prolonging treatment for patients with advanced heart failure. Despite continuous advancements in the field of continuous-flow left ventricular assist devices (CF-LVADs), recipients still face a relatively high incidence of LVAD-related adverse events, with gastrointestinal bleeding (GIB) being one of the most frequent complications. GIB is closely associated with severely impaired quality of life, frequent hospitalizations, need for blood transfusions, and potential mortality in these patients. Furthermore, many patients experience recurrent GIB events, which further exacerbates their discomfort and medical resource utilization. Although various medical and endoscopic treatment strategies exist, evidence regarding their benefits remains largely ambiguous, with all relevant studies based on data from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) rather than clinical trials. While current research provides significant insights into the management of adverse events in LVAD recipients, there is a scarcity of effective and validated indicators and methods for predicting post-implantation GIB events. 1. Case Presentation: We report the case of a 36-year-old male patient with a history of chronic heart failure, diagnosed with dilated cardiomyopathy. While awaiting heart transplantation, the patient experienced worsening heart failure and underwent an emergency LVAD implantation. During the postoperative treatment period, the patient experienced recurrent episodes of GIB that could not be controlled by endoscopic interventions. Ultimately, the patient underwent surgical resection of the bleeding intestinal segment by the gastrointestinal surgery team. Following the surgery, the bleeding ceased, and the patient's bowel function recovered successfully. This case report aims to enrich the literature on GIB following LVAD implantation and its management. 2. Conclusion: Gastrointestinal bleeding is a common complication following LVAD implantation, often requiring endoscopic hemostatic treatment. In refractory cases, surgical resection of the affected intestinal segment may be necessary. Moreover, with frequent bleeding episodes, antiplatelet and anticoagulation therapies often need to be discontinued, which in turn increases the risk of life-threatening events. This case highlights the importance of a multidisciplinary approach in managing GIB in LVAD recipients, as well as the need for further research to develop effective strategies for predicting and preventing this complication.