A multicenter evaluation of external outflow graft obstruction with a fully magnetically levitated left ventricular assist device

Wert, Leonhard; Stewart, Garrick C.; Mehra, Mandeep R.; Milwidsky, Assi; Jorde, Ulrich P.; Goldstein, Daniel J.; Selzman, Craig H.; Stehlik, Josef; Alshamdin, Faisal Dkhalallah; Khaliel, Feras; Gustafsson, Finn; Boschi, Silvia Regina Matos da Silva; Loforte, Antonio; Ajello, Silvia; Scandroglio, Anna Mara; Tučanová, Z.; Netuka, Ivan; Schlöglhofer, Thomas; Zimpfer, Daniel; Zijderhand, Casper F.; Çalışkan, Kadir; Doğan, Güneş; Schmitto, Jan D.; Maier, Sven; Schibilsky, David; Jawad, Khalil; Saeed, Diyar; Faerber, Gloria; Morshuis, Michiel; Hanuna, Maja; Müller, Christoph S.; Mulzer, Johanna; Kempfert, Jörg; Falk, Volkmar; Potapov, Evgenij

doi:10.1016/j.jtcvs.2022.09.051

Cited by 12 publications

(9 citation statements)

References 21 publications

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“…Percutaneous stent implantation played an important role in managing this cohort of patients (15 out of 62 patients). However, the mortality of eOGO with therapeutic intervention reached 17% 9 …”

Section: Discussionmentioning

confidence: 99%

“…However, the mortality of eOGO with therapeutic intervention reached 17%. 9 Endograft infection, the risk for LVAD-related thrombosis, damage to the pump mechanism from catheters or wires, wire or catheter entrapment, and endoleaks are potential hazards of the repair technique. Nevertheless, the endovascular approach outlined appears to be a novel, safe, and viable treatment for LVAD outflow tract pseudoaneurysm that avoids a potentially morbid open operation in a compromised patient population.…”

Section: Discussionmentioning

confidence: 99%

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Endovascular stenting of an HVAD™ outflow graft pseudoaneurysm that exerts compression and kinking stenosis on the soft portion of the prosthesis

Elbayomi

Weyand

Uder

et al. 2023

Clinical Case Reports

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Key Clinical Message Complex presentations of MCS patients may necessitate a multidisciplinary approach involving HF cardiologists, CT surgeons, advanced cardiac imagers, and interventional cardiologists in order to define the optimal management strategy. Abstract Left ventricle assist devices (LVADs) provide life‐sustaining treatment for patients with terminal heart failure, but their intricacy allows for complications. One complication is LVAD outflow graft obstruction due to the graft's intraluminal thrombus or extraluminal compression. It may be treated endovascularly with stenting. We report an endovascular stenting of an outflow tract in HVAD™ (HeartWare Inc.) due to a pseudoaneurysm causing compression and kinking stenosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Endovascular stenting of an HVAD™ outflow graft pseudoaneurysm that exerts compression and kinking stenosis on the soft portion of the prosthesis

Elbayomi

Weyand

Uder

et al. 2023

Clinical Case Reports

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“…These include long-term LVAD support, the use of an extended outflow graft, graft kinking, and the presence of a large gap between the bend relief and the outflow graft. Prolonged LVAD support is generally associated with an elevated risk of eOGO [1,5]. In one study, the rates of eOGO following HM 3 support were 0.6% at 1 year, 2.8% at 2 years, 4% at 3 years, and 9.1% at 5 years [1].…”

Section: Discussionmentioning

confidence: 99%

“…External outflow graft obstruction (eOGO) is a rare but life-threatening complication [1,2]. The outflow grafts of LVAD are typically composed of gelatin-impregnated woven polyester.…”

Section: Discussionmentioning

confidence: 99%

Surgical Correction of Left Ventricular Assist Device Outflow Graft Obstruction Caused by a Wrapped Expanded Polytetrafluoroethylene Graft: A Case Report

Kim,

Park,

et al. 2024

J Chest Surg

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A 70-year-old man with dilated cardiomyopathy underwent left ventricular assist device (LVAD) implantation, using a HeartWare ventricular assist device, as a bridge to candidacy. After 26 months, computed tomography (CT) angiography indicated stenosis in the LVAD outflow graft; however, the patient was asymptomatic, prompting a decision to manage his condition with close monitoring. Ten months later, the patient presented with dizziness and low-flow alerts. Subsequent CT angiography revealed a critical obstruction involving the entire LVAD outflow graft. The patient underwent emergency surgery, during which an organized seroma causing the graft obstruction was found between a wrapped expanded polytetrafluoroethylene (ePTFE) graft and a Dacron outflow graft. The covering of the outflow graft was removed, along with the organized seroma. Following removal of the ePTFE wrap and decompression of the outflow graft, normal LVAD flow was reestablished. The practice of wrapping the outflow graft with synthetic material, commonly done to facilitate later redo sternotomy, may pose a risk for outflow graft obstruction.

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“…In addition to death, stroke, and bleeding, common LVAD-associated adverse events include cardiac arrhythmia, driveline and blood infections, respiratory failure, and right HF. Although rare, external compression of the outflow graft can cause relevant graft obstruction requiring surgical revision or stent implantation [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of an Accessory for Left Ventricular Assist Devices on Device Flow and Pressure Head In Vitro

et al. 2023

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A novel accessory directing the blood from the outflow of a left ventricular assist device (LVAD) back through the left ventricular apex and across the aortic valve allows LVAD implantation via the left ventricular apex solely but may affect the LVAD performance. We quantified the effect of the accessory on LVAD flow and pressure head in vitro. In a mock circulatory loop, a centrifugal-flow LVAD (HeartMate 3, Abbott, Abbott Park, IL, USA) with (Accessory) and without the accessory (Control) was compared under physiological conditions using a water/glycerol solution as a blood substitute. The pump was operated at 4000, 5200, and 6400 rpm and 5 different resistance levels. Flow, inlet, and outlet pressure were measured, and pressure head was calculated. Compared to the Control, flow and pressure head in the Accessory group were reduced by an overall average of 0.26 L/min and 9.9 mmHg (all speeds and resistance levels). The highest decline in flow and pressure head occurred at the lowest resistance levels. In conclusion, the accessory leads to a reduction of LVAD flow and pressure head that is enhanced by decreases in resistance. Future developments in the LVAD accessory’s design may reduce these effects and allow unimpaired LVAD performance and minimally invasive device implantation.

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A multicenter evaluation of external outflow graft obstruction with a fully magnetically levitated left ventricular assist device

Cited by 12 publications

References 21 publications

Endovascular stenting of an HVAD™ outflow graft pseudoaneurysm that exerts compression and kinking stenosis on the soft portion of the prosthesis

Endovascular stenting of an HVAD™ outflow graft pseudoaneurysm that exerts compression and kinking stenosis on the soft portion of the prosthesis

Surgical Correction of Left Ventricular Assist Device Outflow Graft Obstruction Caused by a Wrapped Expanded Polytetrafluoroethylene Graft: A Case Report

Impact of an Accessory for Left Ventricular Assist Devices on Device Flow and Pressure Head In Vitro

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