P3452 - Endoscopic Screening and the Risk of Post Left Ventricular Assist Device Gastrointestinal Bleeding: A Multicenter Retrospective Cohort Study

Award: Presidential Poster Award

Mohamed Azab, MD¹, Jiahao Peng, MD, MPH², Samanthika S. Devalaraju, MD³, William T. Cates, DO³, Molly Stone, MD⁴, Jonathan Reichstein, MD⁵, Sneha Shaha, DO⁶, Subhasis Chatterjee, MD³, Andrew B. Civitello, MD⁷, Mourad H. Senussi, MD, MS³, B. Joseph Elmunzer, MD, MSc⁸, Michael Volk, MD⁹, Wasseem Skef, MD^3
1Prevea Health, Hobart, WI; ²Loma Linda University Health, Loma Linda, CA; ³Baylor College of Medicine, Houston, TX; ⁴University of Michigan, Ann Arbor, MI; ⁵Medical University of South Carolina, Charleston, SC; ⁶Loma Linda University Medical Center, Loma Linda, CA; ⁷Baylor College of Medicine/Texas Heart Institute, Houston, TN; ⁸Medical University of South Carolina, Mount Pleasant, SC; ⁹Loma Linda University, San Bernardino, CA

Introduction: LVADs are increasingly used as life prolonging therapy in advanced heart failure. Unfortunately, post LVAD GI hemorrhage is a common complication, contributing to morbidity and increased healthcare costs. Some centers attempt to mitigate bleeding by utilizing preoperative endoscopic screening; however, the evidence to support this practice is scant. Our study aimed to evaluate whether preoperative screening endoscopy was associated with reduced risk of post-LVAD GI bleeding.

Methods: A multicenter retrospective cohort study was performed at three academic sites of patients who underwent LVAD insertion from 2010 to 2019. Study participants were categorized based on whether they underwent preoperative screening endoscopy or not. Patients were followed for a year after insertion and various outcomes were collected. Primary outcome was bleeding at 1 year. Secondary outcomes were severe bleeding and intraprocedural complications. 398 patients met inclusion criteria. Baseline patient characteristics were compared by using the chi-square test for categorical variables and Wilcoxon rank sum test for continuous variables. Univariable and multivariable logistic regression analyses were performed for primary and secondary endpoints. All P values were two-tailed, with statistical significance thresholds set at p < 0.05. All statistical analyses were performed using SAS Software (version 9.4; SAS Institute Inc. Cary, NC, USA).



Results: Screening cohort had increased bleeding at 1-year (36.2% v 25%, p = 0.019). After adjusting for covariables (age, race, history of GI bleed, CAD, CKD, RV dysfunction, center, PPI use & anticoagulant use) screening cohort remained at increased risk of GI bleed (aOR 1.719 [1.018-2.901], p = 0.0425). Severe bleeding was common (47.4%). Severe bleeding cohort was associated with a borderline-significant trend towards increased LV distention (p=0.083) and supratherapeutic INR (p=0.097). AVMs (55.5%) and peptic ulcer disease (37.5%) were the most common identified source of bleeding. Only 1 complication was reported with screening endoscopy.

Discussion: Our study suggests that pre-LVAD endoscopic screening is safe, but increases rather than decreases risk of GI bleed post LVAD, despite controlling for known confounders. While this was an observational study and thus may not have captured all confounders, it appears that endoscopic screening may not be warranted.



Disclosures:


Mohamed Azab, MD¹, Jiahao Peng, MD, MPH², Samanthika S. Devalaraju, MD³, William T. Cates, DO³, Molly Stone, MD⁴, Jonathan Reichstein, MD⁵, Sneha Shaha, DO⁶, Subhasis Chatterjee, MD³, Andrew B. Civitello, MD⁷, Mourad H. Senussi, MD, MS³, B. Joseph Elmunzer, MD, MSc⁸, Michael Volk, MD⁹, Wasseem Skef, MD³. P3452 - Endoscopic Screening and the Risk of Post Left Ventricular Assist Device Gastrointestinal Bleeding: A Multicenter Retrospective Cohort Study, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.