Safety of Colonoscopies in Patients on Advanced Heart Failure Therapies Who Received a Heart Transplant

Introduction

Patients undergoing evaluation for a heart transplant are frequently on inotropic medications or mechanical circulatory support (MCS) devices, which places them at a higher risk for anesthesia-related complications. These patients often require colonoscopies for bleeding or screening purposes, but there are limited data on the safety and outcomes of colonoscopy in this setting.

Methods

This is a retrospective, two-center study between the years 2015 and 2021 of patients with heart failure who subsequently underwent a heart transplant. To be included in the study, patients were required to be on advanced heart failure therapies at the time of colonoscopy. Advanced heart failure therapies were defined as requiring inotropes (milrinone or dobutamine), vasopressors (norepinephrine or vasopressin), or MCS such as an impella, left ventricular assist device (LVAD), intra-aortic balloon pump (IABP), or extra-corporeal membrane oxygenation (ECMO). Indications for colonoscopy, adequacy of bowel preparation, and complications were reported.

Results

A total of 92 patients were included in the study. The most common indication was colon cancer screening (67%), and the remainder were performed due to gastrointestinal bleeding. An inadequate bowel preparation was reported on 20% of patients, but the cecum was reached in all of them. There was no association between the inadequacy of bowel preparation and the presence of MCS (20% vs. 17%, p value 0.67). In colonoscopies performed for screening, 8% (5/62) of patients were found to have an advanced adenoma. In colonoscopies performed for bleeding, 17% (5/30) had a source that required therapeutic intervention and use of hemostatic clips was the preferred modality. Only four patients had a complication of bleeding requiring clips after polypectomy during the index procedure, with no anesthesia-related adverse events (such as hypotension, arrhythmias, or cardiac arrest) or addition of inotropes, vasopressors, or MCS.

Discussion

Colonoscopy in patients on advanced heart failure therapies is acceptable with not only a low rate of complications but also a high rate of inadequate bowel preparation.