Severe Pulmonary Bleeding after Assist Device Implantation: A Case Series

Background: Left ventricular assist device (LVAD) implantation is an established treatment for patients with advanced heart failure. Although bleeding is a well-known complication of LVAD patients, most publications only report on gastrointestinal (GI) bleeding. The aim of this report is to discuss our experiences of severe pulmonary bleeding (SPB) as a complication after LVAD implantation.

Methods: We retrospectively evaluated 97 patients who underwent LVAD implantation between 2008 and 2016. Four patients (4.1%) developed SPB postoperatively, requiring blood transfusion and administration of coagulation products.

Results: Two patients were male; 1 suffered from ischemic, and 3 from dilative cardiomyopathy. None of the patients had a history of lung disease. Intraoperative complications were not noted. Postoperatively, the patients suffered from persistent respiratory insufficiency due to severe pneumonia requiring prolonged mechanical ventilation with daily bronchoscopy and endotracheal suction. First episode of lung bleeding occurred after 9, 11, 15, and 29 days. As a consequence of bleeding, gas exchange worsened significantly, and the implantation of a veno-venous extracorporeal membrane oxygenation (ECMO) was inevitable in one case. Extended coagulation diagnostics revealed an acquired von Willebrand Disease in all cases, and application of von Willebrand Factor was performed consecutively.

After serious efforts and substitution of coagulation products, bleeding could be stopped in 3 of 4 patients. One patient died after 6 weeks on ECMO.

Conclusion: Severe pulmonary bleeding is a rare but serious complication after LVAD implantation. Possible causes might be pulmonary congestion prior surgery facilitating postoperative pneumonia with subsequent need for frequent endotracheal suction or bronchoscopy.