Abstract 209: The Safety of Emergent Bedside Gastrointestinal Endoscopy in Patients with Moderate and Severe Aortic Stenosis in the Cardiac Intensive Care Unit
Purpose: Recent advances in the management of aortic stenosis (AS) including the availability of percutaneous valve therapies have resulted in the evaluation of patients with increased co-morbidities. AS is associated with an increased risk of Gastrointestinal (GI) bleeding which is further increased by antithrombotic and antiplatelet treatment that often accompany hospitalization. The aim of our study was to determine the safety of emergent bedside endoscopies in patients with moderate to severe AS in the Cardiac Intensive Care Unit (CICU) setting presenting with acute GI bleeding.
Objective and Methods: We identified all patients with moderate to severe AS who were admitted to the CICU at the Cleveland Clinic and experienced GI bleeding requiring emergent bedside endoscopies between Jan 2011 and Jan 2013. Data collection included demographics, indication for admission to the CICU, indication for bedside endoscopy, etiologies of GI bleeding, and intra procedural as well as post procedural hemodynamic instability and respiratory distress. AS was defined as moderate for aortic valve area (AVA) in the range 1.5-1.00 cm square and severe for AVA < 1.00 cm square.
Result: 17 patients (10 males) with a mean age 78.4 ± 10.6 years were identified. Overall 4 patients had moderate AS while 13 had severe AS. The peak gradient across the aortic valve was 53.8 ± 24.8 with a mean AVA 0.74 ± 0.25 cm square. Indication for urgent bedside endoscopies included episodes of acute melena, hematemesis, acute anemia of an undetermined etiology, in addition to evaluation of acute anemia in the perioperative period. 88% of patients were on either antiplatelet or anticoagulation or both. The patients underwent a total of 20 bedside endoscopies: 16 upper endoscopies and 4 colonoscopies. IV fentanyl and midazolam were used for sedation in patients not previously intubated. The etiologies of GI bleeding were peptic ulcer disease (n=5), hemorrhagic gastritis (n=5), esophagitis with esophageal ulcer (n=3), GI angiodysplasias (n=3), and diverticulitis (n=1). None of the patients developed acute hemodynamic instability or acute respiratory distress during or after the endoscopy.
Conclusion: The etiologies of acute bleeding in patients with AS are diverse. Emergent bedside GI endoscopies done in the CICU for the diagnosis and management of acute GI bleeding is a safe procedure in patients with moderate to severe AS.
Author Disclosures: N.N. Faza: None. I. Hanouneh: None. A. Krishnaswamy: None. V. Menon: None.
- © 2014 by American Heart Association, Inc.