Extracorporeal membrane oxygenation‐assisted emergency percutaneous treatment of left ventricular assist device graft occlusion

Abstract

End-stage heart failure is more often treated with Implantable left ventricular assist device (LVAD), even if the prolonged use may increase the risk of complications. In this case, a 51-year-old male patient presented to our emergency department showing acute heart failure signs and symptoms and a dramatic reduction of LVAD flow. Laboratory tests ruled out significant haemolysis, usually associated with pump thrombosis. The echocardiogram and the computed tomography were not able to clarify the correct diagnosis. We immediately placed a veno-arterial extracorporeal membrane oxygenation, followed by a selective retrograde angiography of the pump. The images showed stenosis of the LVAD-outflow graft, suggesting a twist. Through a handmade J-tip guidewire, we performed multiple dilatations of the occlusion using peripheral balloons. Finally, we implanted an aortic coarctation covered-stent, re-establishing an adequate cardiac output to the patient. Our case indicates that catheter-based approach in extracorporeal membrane oxygenation assistance provides an important therapeutic alternative to treat outflow graft stenosis, especially in the case of acutely unstable patient.

Outcomes of outflow graft stenting in HeartMate 3 left ventricular assist devices: A systematic review and individual patient data meta‐analysis

“…Thirteen studies 6,9–20 and one unpublished case (performed at Thomas Jefferson University Hospital) were used for analysis, yielding a total of 28 patients with HM3 outflow graft stenosis that underwent stenting. Patient‐level data were extracted for statistical analysis.…”

A Case of Successful Use of the “Anchoring Technique” for Percutaneous Treatment of Left Ventricular Assist Device Graft Occlusion

“…Despite surgical redo is often required in these patients, it can be associated with an unacceptably high peri-procedural risk in certain cases. In these selected cases, to reduce this risk, percutaneous approach can be chosen with the purpose to rapidly restore LVAD flow [4], especially in unstable patients.…”

“…In these patients, left ventricular assist devices (LVAD) have been demonstrated to be an effective strategy and are often used as destination therapies or as bridge to heart transplantation [2]. Nevertheless, with the increasing number of patients undergoing LVAD implantation, the device-related complications are progressively increasing as well [4,5]. LVAD obstruction is a rare but potentially dramatic complication, which can be associated with high rates of mortality due to severe refractory HF.…”

A Redo Percutaneous Emergency Intervention of Left Ventricular Assist Device Graft Occlusion

“…Despite being considered an uncommon event [3], outflow graft obstruction (OGO) is progressively recognized as a relevant cause of LVAD failure and its incidence may be superior to 5% [5]. In these patients, percutaneous treatment with 2 of 8 stent implantation can be a life-saving intervention [6] and it has been proposed as a first step strategy in order to avoid high risk surgical redo [7]. Nevertheless, data regarding long term clinical outcome and stent patency in patients suffering OGO previously treated with a percutaneous approach are critically lacking.…”