Transaxillary Stenting of LVAD Outflow Graft Obstruction

Abstract

An 82-year-old man with a HeartMate II left ventricular assist device presented with low-flow alarms and cardiogenic shock secondary to left ventricular assist device outflow graft obstruction. Given high risk for redo sternotomy, the heart team decided on percutaneous intervention with peripheral stents, a procedure that is currently limited to case reports. ( Level of Difficulty: Advanced. )

Percutaneous endovascular stenting to treat left ventricular assist device outflow graft stenosis

“…Several case reports and series describe OGS and its endovascular treatment options. 4 , 5 , 8 , 9 , 10 Patients with LVAD obstructions often present with low-flow alarms and cardiogenic shock, frequently diagnosed with CT scans, angiography, presentation, and history. 4 , 5 , 8 , 9 , 10 There might be a role for intravascular ultrasound; however, we sought to minimize the number of wire exchanges and had effective sizing parameters determined from a gated CT scan.…”

“… 4 , 5 , 8 , 9 , 10 Patients with LVAD obstructions often present with low-flow alarms and cardiogenic shock, frequently diagnosed with CT scans, angiography, presentation, and history. 4 , 5 , 8 , 9 , 10 There might be a role for intravascular ultrasound; however, we sought to minimize the number of wire exchanges and had effective sizing parameters determined from a gated CT scan. Comparisons in LVAD settings, before and after intervention, between our patient and literature-reviewed data are reported in Tables I and II .…”

“…Comparisons in LVAD settings, before and after intervention, between our patient and literature-reviewed data are reported in Tables I and II . 5 , 6 , 8 , 9 , 11 , 12 , 13 , 14 The reasons for OGS include kinks and thrombosis, often in covered sections of the graft. 4 , 12 In our patient, the stenosis was most likely due to OG thrombosis, supported by the echocardiographic and cross-sectional imaging findings.…”