Anemia after continuous-flow left ventricular assist device implantation: characteristics and implications



Anemia is common in patients with heart failure and is associated with adverse outcomes. Management of anemia in CF-LVAD patients is not well studied. Our purpose is to characterize and identify the etiology of anemia in CF-LVAD patients. Secondary objectives are to describe the effect of CF-LVAD on pre-existing anemia and assess its impact after CF-LVAD support.


Cross-sectional study from January to July 2015 of ambulatory patients supported with a CF-LVAD for at least 6-months that presented with hemoglobin <12 g/dL and no recent gastrointestinal bleeding. Patients were classified as iron-deficient and non-iron-deficient and compared. Additionally, a retrospective analysis of 116 consecutive patients who underwent CF-LVAD from 2008 to 2013 with reported hemoglobin at 6 months as outpatients were divided into anemic or non-anemic and compared.


In our cross-sectional cohort, iron deficiency was the most common cause of anemia. Notably, 49% of the iron-deficient patients were already on iron supplementation. In our retrospective cohort, 59% of the patients were anemic after 6 months of support. Anemic patients were older, had lower albumin, higher brain natriuretic peptide (BNP), worse renal function and New York Heart Association (NYHA) class. Anemia had a HR of 3.16 (95%CI 1.38-7.26) to predict a composite of 1-year death and HF readmissions, as well as HF-readmissions alone.


The most common cause of anemia in our study was iron-deficiency; almost half of the patients were iron deficient despite treatment, suggesting that oral iron may not be sufficient to reverse anemia. Anemia regardless of etiology was associated with adverse outcomes.

Int J Artif Organs 2017; 40(9): 481 - 488




Javier Amione-Guerra, Ana S. Cruz-Solbes, Arvind Bhimaraj, Barry H. Trachtenberg, Sai R. Pingali, Jerry D. Estep, Myung H. Park, Ashrith Guha

Article History


Financial support: No grants or funding have been received for this study.
Conflict of interest: Dr. Jerry D. Estep and Dr. Arvind Bhimaraj are consultants for St. Jude Medical™ (St. Paul, MN, USA).

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  • Houston Methodist Hospital, Houston, TX - USA

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