Acute Left Ventricular Assist Device Failure From Outflow Graft Dissection Flap Successfully Treated With Stent Placement

Abstract

Outflow graft obstruction (OGO) is a potentially fatal complication of left ventricular assist device (LVAD) implantation. Common causes include graft kinking, luminal stenosis, and graft thrombosis. We describe a case of a 51-year-old female who presented with acute LVAD failure and cardiogenic shock. Initial imaging revealed OGO without luminal stenosis following which she was she was empirically treated for graft thrombosis with anticoagulation and catheter-based thrombolytic therapy with no success. Further imaging in the catheterization laboratory revealed a potential neointimal flap dissection acting as a one-way valve. A stent was successfully placed across the outflow graft with immediate resolution of cardiogenic shock. The case emphasizes the importance of including neointimal flap as a differential for OGO in acute LVAD failure, especially in cases where thrombolytic therapy fails to correct hemodynamic compromise.

Acute Outflow Graft Occlusion—A Novel Predictable Complication of Lysis Therapy for the Treatment of Left Ventricular Assist Device Intra-Pump Thrombosis

“…In general, OGO can be caused by an intraluminal thrombus, neointima dissection, extraluminal biodebris, and twisting or kinking of the graft. [24][25][26] In our cohort, kinking and twisting of the graft can be excluded. Kinking due to an excess length of the OG typically occurs during or shortly after implantation and for twisting, stenting of the graft would not have been a successful approach to recover LVAD flow.…”