Percutaneous treatment of left ventricular assist device outflow graft obstruction

Abstract

Owing to the growing population with end stage heart failure, the use of left ventricular assist devices (LVADs) have become more widely accepted. Although survival has improved with newer generation LVADs, multiple complications including pump failure due to outflow graft obstruction have become more clinically relevant. Patients with this complication will present with heart failure symptoms due to inadequate unloading of the left ventricle by LVAD. This rare complication often requires open surgical repair in an already high-risk patient population. Alternative means to relieve the obstruction via percutaneous intervention has been described in rare cases. We present two unique cases of LVAD outflow graft obstruction which were percutaneously treated successfully. This article illustrates a potential treatment strategy for outflow graft obstruction with stenting as an alternative to open-heart surgery.

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

“…The reasons for the case conversion to open surgical revision were variable and relatively unpredictable. Previous studies recommend surgical repair for outflow graft obstruction in cases where the outflow graft obstruction is exceptionally large and, especially, in cases where the presence of concomitant conditions necessitates surgical repair 23 . In the three patients requiring open surgical revisions, percutaneous stenting was always pursued first, and only if deterioration occurred was an open surgical revision done.…”

“…the outflow graft obstruction is exceptionally large and, especially, in cases where the presence of concomitant conditions necessitates surgical repair. 23 In the three patients requiring open surgical revisions, percutaneous stenting was always pursued first, and only if deterioration occurred was an open surgical revision done. Indications for heart transplant in two patients were due to first, recurrent driveline infection and second, septic infection along with recurrent bleeding from the outflow graft which led to a delayed transplantation.…”

Percutaneous Intervention of LVAD Outflow Graft Obstruction and Thrombosis

“…7,8 Open surgical repair remains the primary approach for managing LVAD thrombosis, especially in cases where the etiology is prepump or intrapump. [9][10][11] Thrombolytics also serve as effective agents for the treatment of prepump or intrapump thrombosis, administered either systemically or through in-device therapy via a transfemoral catheter approach. 12 However, the literature lacks sufficient data on the efficacy of thrombolytic therapy in outflow graft occlusions.…”

“…13 Percutaneous intervention has been detailed in a limited number of reports and case series and has proven successful to date. [9][10][11] This approach is particularly valuable due to its feasibility, cost-effectiveness, less invasiveness, and low risk of morbidity, making it beneficial for high-risk surgical patients. A thoughtful and multidisciplinary approach is essential in determining the best course of action for each scenario.…”