A report on interventional acute bare -metal stenting of the HeartMate 3 left ventricular assist device twisted outflow graft

Juraszek, Andrzej; Szymański, Jarosław; Demkow, Marcin; Kuśmierczyk, Mariusz

doi:10.33963/kp.15501

Cited by 3 publications

(6 citation statements)

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“…suggest the use of minimally invasive surgical procedures to untwist the graft and, in select cases, the additional insertion of a customized titanium cuff to prevent the graft from twisting again 7 . Outflow graft stenting procedures with favourable results have been described 4,6,8 . The establishment of optimal treatment depends on the patient's clinical state, eligibility for reoperation or heart transplantation, and the experience of the cardiac surgeons and interventional cardiologists.…”

Section: Discussionmentioning

confidence: 99%

“… 7 Outflow graft stenting procedures with favourable results have been described. 4 , 6 , 8 The establishment of optimal treatment depends on the patient's clinical state, eligibility for reoperation or heart transplantation, and the experience of the cardiac surgeons and interventional cardiologists. Interestingly, in the majority of cases described in the literature, the transcatheter procedure had been performed using only one stent at the location of the twist.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of outflow graft twist has been reported as 0.72% for the HeartMate 3 device (Abbott, Abbott Park, IL, USA) 3 . Treatment of LVAD complications includes urgent heart transplantation, device reimplantation, thrombolytic therapy, and interventional transcatheter procedures 4 …”

Section: Introductionmentioning

confidence: 99%

“… 3 Treatment of LVAD complications includes urgent heart transplantation, device reimplantation, thrombolytic therapy, and interventional transcatheter procedures. 4 …”

Section: Introductionmentioning

confidence: 99%

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Successful percutaneous treatment of late outflow graft failure of the left ventricular assist device: a long‐term follow‐up

et al. 2021

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Continuous flow left ventricular assist device (LVAD) outflow graft stenosis constitutes a severe complication. Treatment options include surgical pump exchange, transcatheter procedures, or systemic thrombolysis. We present a case of a spontaneous mechanical twisting of the outflow graft at two distinct points, which was treated by a two‐step percutaneous stent implantation. Self‐expanding stents were used during the first procedure. We also ensured distal bilateral percutaneous neuroprotection against cerebrovascular embolism. During the second, previously unpredicted procedure, we used balloon‐expandable bare‐metal stents to overcome the torque of the graft, because of their higher radial force. It was assumed that the external, self‐expanding layer of the stent might protect the graft from the bare‐metal stents. The effects of the treatment were monitored both clinically and through computed tomography angiography. The check‐up 12 months later revealed nothing of note. Interventional transcatheter procedures are a safe treatment option for outflow graft stenosis, with good long‐term effects. Both self‐expanding and balloon‐expandable stents can be used for transcatheter intervention. Both the incidence of the graft twisting and the radial force of the implanted stent seem to be critical and robust predictors of the long‐term result of percutaneous therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“… 3 Treatment of LVAD complications includes urgent heart transplantation, device reimplantation, thrombolytic therapy, and interventional transcatheter procedures. 4 …”

Section: Introductionmentioning

confidence: 99%

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Successful percutaneous treatment of late outflow graft failure of the left ventricular assist device: a long‐term follow‐up

et al. 2021

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“…Using IVUS with blood flow visualizing software, we documented the mechanism of outflow graft narrowing at the site of its anastomosis with the aorta that was associated with inner lumen presence of a hyperechogenic tissue flap caused by a localized pseudo intimal graft dissection detached from the textured inner surface of a Dacron graft. This dissection propagated in the blood flow direction with the space between the inner graft surface and the flap that was filled with the flowing blood (thus not excessive tissue ingrowth, thrombus formation nor kink) [1,2]. Using IVUS, we also documented pseudointimal ingrowth along the entire outflow graft length and identified other sites of dissection located distally, but near the LVAD outflow (Supplementary material, Figure S2A, cross-section no.…”

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confidence: 88%

Intravascular ultrasound with blood flow visualization to detect pseudo intimal graft dissection as a cause of left ventricular assist device outflow graft stenosis

et al. 2021

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

Patil,

Ahmad,

Shah

et al. 2024

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PurposeLVAD outflow graft stenosis continues to remain prevalent with a high complication rate. We sought to pool the existing evidence on indications, utilization patterns, and outcomes of transcatheter interventions for outflow graft stenosis in the HeartMate 3 LVAD.MethodsAn electronic search was performed to identify all studies in the English literature reporting on HeartMate 3 LVAD outflow graft stenting. Patient‐level data were extracted for analysis.ResultsThirteen published reports and one unpublished case comprising a total of 28 patients were included. Median patient age was 68.5 years [Interquartile range: 58, 71] and 25.9% (7/27) were female. Dyspnea [60.7% (17/28)] was the most common presenting symptom. Low flow alarms were present in 60% (15/25) of patients. Findings included external compression [35.7% (10/28)], graft twist [21.4% (6/28)], graft twist and external compression [14.3% (4.28)], intraluminal thrombus [10.7% (3/28)], graft twist and intraluminal thrombus [3.6% (1/28)], and pseudoaneurysm of outflow graft [3.6% (1/28)]. Median time from LVAD implantation to stenting was 2.1 years [1.4, 3]. Immediate flow normalization after stenting was observed in 85.7% (24/28). The 30‐day mortality was 12% (3/25). Overall mortality was 12% (3/25) at a median follow‐up of 3.9 months [1, 17].ConclusionOutflow graft stenting in the HeartMate 3 LVAD appears to be a reasonable treatment option for outflow graft stenosis, with low overall rates of complications and mortality. Further refinement of indications and approaches may improve outcomes.

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A report on interventional acute bare -metal stenting of the HeartMate 3 left ventricular assist device twisted outflow graft

Cited by 3 publications

References 1 publication

Successful percutaneous treatment of late outflow graft failure of the left ventricular assist device: a long‐term follow‐up

Successful percutaneous treatment of late outflow graft failure of the left ventricular assist device: a long‐term follow‐up

Intravascular ultrasound with blood flow visualization to detect pseudo intimal graft dissection as a cause of left ventricular assist device outflow graft stenosis

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

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