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Risk factors of gynecological bleeding in female patients with left-ventricular assist device

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  • Artificial Heart (Clinical)
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Abstract

Women with implantable left-ventricular assist devices (LVADs) experience gynecological bleeding (GYN-bleeding). However, a few studies have investigated female-specific problems. Therefore, this study aimed to identify the risk factors for adverse GYN-bleeding after LVAD implantation. We retrospectively analyzed 59 women (mean age: 41 ± 15 years) with long-term implantable LVAD support (≥ 6 months) at our institution between 2005 and 2018. The history of GYN-bleeding before implantation was defined as abnormal utero-ovarian bleeding, excessive menstruation, uterine fibroids, and endometrial lesions. GYN-bleeding after implantation was defined as a requirement of emergency outpatient visits and/or hospitalization, blood transfusions, hormonal therapy, and/or surgery. Additionally, risk factors for GYN-bleeding were identified using the Cox regression model. Twenty-four GYN-bleeding cases were seen in 15 patients (two times: five patients, three times: two patients, 0.18 events per patient-year). The 1- and 2-year GYN-bleeding-free rates were 84% and 73%, respectively. Twelve patients (17 events) required RBC ≥ 4 units, and five patients (7 events) required FFP ≥ 4 units. Seven patients required pseudomenopausal treatment after blood transfusion, and four patients required surgical treatment. Fifteen patients with GYN-bleeding after implantation were significantly younger than the remaining 44 patients without GYN-bleeding (34 ± 12 years vs. 43 ± 16 years, P = 0.02). Multivariable risk analysis showed a history of GYN-bleeding before implantation was a significant risk factor (hazard ratio 3.7 [1.2–10.6], P = 0.004). Patients with a history of GYN-bleeding before LVAD implantation have a high risk of developing GYN-bleeding after implantation. We should identify the high-risk population and prepare for the management of GYN-bleeding.

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Acknowledgements

The authors would like to thank Editage (http://www.editage.jp) for English language editing.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Yamadaoka, 2-2, Suita, Osaka, 565-0871, Japan

    Yuji Tominaga, Daisuke Yoshioka, Koichi Toda, Tetsuya Saito, Takuji Kawamura, Noriyuki Kashiyama, Ai Kawamura, Ryohei Matsuura, Takuji Watanabe, Masaki Taira & Shigeru Miyagawa

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  1. Yuji Tominaga
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  2. Daisuke Yoshioka
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  3. Koichi Toda
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  7. Ai Kawamura
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Contributions

All authors contributed to the study concept and design. Material preparation, data collection, and analysis were performed by YT, DY, KT, TS, TK, NK, AK, RM, TW, MT, and SM. The first draft of the manuscript was written by YT and all authors commented on the manuscript. All authors have read and approved the manuscript.

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Correspondence to Yuji Tominaga or Daisuke Yoshioka.

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Tominaga, Y., Yoshioka, D., Toda, K. et al. Risk factors of gynecological bleeding in female patients with left-ventricular assist device. J Artif Organs 25, 110–116 (2022). https://doi.org/10.1007/s10047-021-01292-2

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  • DOI: https://doi.org/10.1007/s10047-021-01292-2

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