Interventional Procedures for Left Ventricular Assist Device-Associated Complications

Abstract

As patients on long-term left ventricular assist device (LVAD) face a substantial risk for open cardiac reoperation, interventional treatment approaches are becoming increasingly important in this population. We evaluated data of 871 patients who were on LVAD support between January 1, 2016 and December 1, 2020. Interventional treatments for LVAD-associated complications were performed in 76 patients. Seventeen patients underwent transcatheter aortic valve replacements (TAVR) and 61 patients underwent outflow graft interventions (OGI). TAVR improved symptoms in patients with severe symptomatic aortic regurgitation. Postinterventional complications included aggravation of preexisting right heart failure (RHF), third-degree atrioventricular block, and intrapump thrombosis (in 3 [16.7%], 2 [11.1%], and 1 [5.6%] patients, respectively). In outflow graft obstructions, OGI led to recovery of LVAD flow (p < 0.001), unloading of the left ventricle (p = 0.004), decrease of aortic valve opening time (p = 0.010), and improvement of right heart function (p < 0.001). Complications included bleeding, RHF, and others (in 9 [10.8%], 5 [6.0%], and 5 [6.0%] patients, respectively). Eight (9.6%) patients died within the hospital stay after OGI, including mortality secondary to prolonged cardiogenic shock. In conclusion, interventional procedures are a feasible and safe treatment modality for LVAD-associated complications.

Artificial intelligence‐based analysis of body composition predicts outcome in patients receiving long‐term mechanical circulatory support

“…Women were underrepresented in this analysis, which is typical for LVAD studies and mainly due to the lower implantation rate in women. 11,19,38,39 In conclusion, AI-derived body composition represents an accessible method that can be performed post-processing with imaging data that derives from diagnostics that are routinely conducted in preparation for LVAD implantation. AI-based body composition analyses provide a comprehensive survey of muscle and adipose tissue, allowing a precise characterization of preoperative risk factors.…”

Endovascular stenting of an HVAD™ outflow graft pseudoaneurysm that exerts compression and kinking stenosis on the soft portion of the prosthesis

“…An endovascular repair can offer a less invasive non‐inferior outcome for post‐pump flow obstruction in selected patients 6,7 . Outflow graft intervention could show evidence of efficacy in outcome in terms of recovery of LVAD flow, unloading of the left ventricle, decrease in the aortic valve opening time, and a subsequent improvement of the right heart function due to decrease of afterload in the pulmonary circulation 8 …”

Acute Outflow Graft Occlusion—A Novel Predictable Complication of Lysis Therapy for the Treatment of Left Ventricular Assist Device Intra-Pump Thrombosis

“…Patients with highly suspected OGO defined by 1) HVAD low-flow alarms due to an abrupt drop of LVAD flow in the LVAD log-file analysis, 2) with or without symptoms or signs of acute heart failure, and 3) during or 24 hours after lysis therapy, were immediately referred to fluoroscopic angiography of the outflow graft and treated by stent implantation, after angiographic confirmation of diagnosis. 13…”