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LVAD Complication - GI Bleeding — EECC MCQ

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HardHeart FailureLVAD Complication - GI BleedingEECC

A 55-year-old man with a continuous-flow left ventricular assist device (LVAD) as a bridge to transplant presents with dark-coloured stools and a haemoglobin drop from 120 to 78 g/L over 2 weeks. Upper GI endoscopy shows multiple gastric angiodysplastic lesions. What is the underlying pathophysiology of this complication?

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Correct answer: C — Acquired von Willebrand syndrome due to shear stress degradation of vWF multimers

GI bleeding from angiodysplasia is the most common bleeding complication in patients with continuous-flow LVADs. The mechanism is acquired von Willebrand syndrome (AvWS): high shear stress within the pump degrades large von Willebrand factor multimers (similar to Heyde syndrome in aortic stenosis). This, combined with the low-pulsatility flow promoting angiodysplasia formation and concurrent anticoagulation, creates a high bleeding risk. Management includes reducing anticoagulation intensity, octreotide, and potentially pump speed reduction to restore some pulsatility.

Reference: ISHLT Guidelines on Mechanical Circulatory Support; ESC (2023): HF Guidelines