Outflow Graft Obstruction Causing Recurrent Heart Failure after Left Ventricular Assist Device Implantation

Burke, Michael A.; Alexy, Tamás; Kamioka, Norihiko; Shafi, Taimur T.; Turbyfield, C.T.; Stowe, Judson; Porter, Joseph; Iturbe, Jose Miguel; Kim, D.W.; Wittersheim, Kris; Nguyen, Duc; Laskar, Sonjoy; Gupta, Divya; Bhatt, Kunal; Smith, Andrew L.; Cole, Robert T.; Morris, Alanna A.; Vega, J. David; Babaliaros, Vasilis

doi:10.1016/j.healun.2020.01.947

The Journal of Heart and Lung Transplantation

2020

DOI: 10.1016/j.healun.2020.01.947

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Outflow Graft Obstruction Causing Recurrent Heart Failure after Left Ventricular Assist Device Implantation

Michael A. Burke

Tamás Alexy

Norihiko Kamioka

et al.

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“…1b). The patient recovered uneventfully after this procedure.The incidence of outflow graft stenosis ranges from 0.01 to 0.03 per patient-year [4,5]. Personalised anticoagulation protocols and surgical implantation techniques are currently being studied to prevent LVAD outflow graft obstruction due to stenosis, thrombosis or torsion.…”

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confidence: 99%

A routine intervention in a highly unusual vessel

et al. 2021

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A 31-year-old woman with a HeartWare TM (Medtronic, Minneapolis, MN, USA) left ventricular assist device (LVAD), which had been implanted for ischaemic cardiomyopathy, presented with progressive dyspnoea. Bilateral pneumonia was suspected. Despite antibiotic treatment, the patient's condition deteriorated: she became more dyspnoeic and developed cardiogenic shock with a low LVAD flow. Computed tomography angiography showed an intraluminal focal outflow graft stenosis. In a multidisciplinary team discussion, the patient was scheduled for an emergency percutaneous intervention via a femoral approach to avoid surgery, based on previous reports [1-3]. Angiography confirmed the stenosis, with an invasive peak-peak gradient of 80 mm Hg (Fig. 1a). This was treated with an Advanta V12 balloon-expandable covered stent (10 mm × 38 mm) and post-dilated with an Advance balloon (10 mm × 20 mm), resulting in a residual gradient of 10 mm Hg and an immediate increase in LVAD flow (Fig. 1b). The patient recovered uneventfully after this procedure.The incidence of outflow graft stenosis ranges from 0.01 to 0.03 per patient-year [4,5]. Personalised anticoagulation protocols and surgical implantation techniques are currently being studied to prevent LVAD outflow graft obstruction due to stenosis, thrombosis or torsion.

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A routine intervention in a highly unusual vessel

et al. 2021

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Outflow Graft Obstruction Causing Recurrent Heart Failure after Left Ventricular Assist Device Implantation

Cited by 1 publication

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A routine intervention in a highly unusual vessel

A routine intervention in a highly unusual vessel

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