Percutaneous Management of Outflow Graft Obstruction in Patients With Continuous Flow Left Ventricular Assist Devices

Davila, Carlos D.; Kiernan, Michael S.; Kapur, Navin K.

doi:10.1016/j.jaccas.2019.09.027

Cited by 5 publications

(3 citation statements)

References 5 publications

(7 reference statements)

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“…6 Pump thrombosis is more common than graft thrombosis and factors that play a role in thrombus formation include patient characteristics (hemocompatibility), suboptimal anticoagulation, or mechanical issues Outflow kinks and polytetrafluoroethylene covering alongside the graft have also been linked to the development of outflow thrombosis. 4,7 On initial graft angiography, in this case, an OGO was indeed visualized with a filling defect, and localized thrombolysis failed to improve flow parameters. This raised concerns about the presence of a nonthrombotic, anatomical obstruction in the outflow tract, which was identified as a flail neointimal flap on repeat angiography.…”

Section: Discussionmentioning

confidence: 78%

“…2 LVAD outflow graft obstruction (OGO) is a dreaded complication with the most common culprit being kinking secondary to external compression followed by graft thrombosis and luminal stenosis. [3][4][5] Herein, we describe a case of a patient who presented with a clinical picture of an OGO 6 years after LVAD placement who had a complicated hospital course and was found to have a unique etiology of the obstruction.…”

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confidence: 99%

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Acute Left Ventricular Assist Device Failure From Outflow Graft Dissection Flap Successfully Treated With Stent Placement

et al. 2022

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Outflow graft obstruction (OGO) is a potentially fatal complication of left ventricular assist device (LVAD) implantation. Common causes include graft kinking, luminal stenosis, and graft thrombosis. We describe a case of a 51-year-old female who presented with acute LVAD failure and cardiogenic shock. Initial imaging revealed OGO without luminal stenosis following which she was she was empirically treated for graft thrombosis with anticoagulation and catheter-based thrombolytic therapy with no success. Further imaging in the catheterization laboratory revealed a potential neointimal flap dissection acting as a one-way valve. A stent was successfully placed across the outflow graft with immediate resolution of cardiogenic shock. The case emphasizes the importance of including neointimal flap as a differential for OGO in acute LVAD failure, especially in cases where thrombolytic therapy fails to correct hemodynamic compromise.

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Section: Discussionmentioning

confidence: 78%

mentioning

confidence: 99%

Acute Left Ventricular Assist Device Failure From Outflow Graft Dissection Flap Successfully Treated With Stent Placement

et al. 2022

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“…Different etiologies of OGO have been described, including isolated thrombosis, kinking, outflow torsion, external bend relief compression and others [11]. In these patients, percutaneous treatment can be highly effective in restoring LVAD function and avoiding high-risk surgical redo [10,12,13], even if highly complex anatomical scenarios can be encountered [8].…”

Section: Discussionmentioning

confidence: 99%

A Redo Percutaneous Emergency Intervention of Left Ventricular Assist Device Graft Occlusion

Stio

Comisso

Paolucci

et al. 2022

IJERPH

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In patients with advanced heart failure (HF), left ventricular assist devices (LVADs) have demonstrated to be effective in improving the quality of life and reducing further hospitalizations. Although uncommon, LVAD outflow graft obstruction (OGO) is a potentially life-threatening complication and percutaneous treatment has been proposed as a standard intervention strategy in such cases. We report the case of a 69 year old man admitted due to LVAD failure causing unstable HF. Past medical history included percutaneous intervention on the outflow graft with stent implantation one year before. The patient was under chronic treatment with vitamin K antagonists (VKA). Emergent percutaneous angiography was performed, showing recurrent OGO due to thrombosis located at a kinking site, distally to the previously treated segment. Using distal anchoring technique, a balloon-expandable 10 × 79 mm endoprosthesis (GORE® Viabahn® VBX) was effectively positioned and post-dilated. Final angiography confirmed the patency of the stent implanted one-year before. Despite the procedure succeeding in restoring LVAD function, the patient died due to septic shock ten days after. Our case suggests that recurrent OGO can be effectively treated with percutaneous redo and that long-term stent patency can be achieved with a standard antithrombotic treatment, despite further thrombotic events in other segments of the graft are still possible (especially at the kinking site). Moreover, other noncardiac conditions as infective complications, can dramatically impact the clinical course and lead to unfavorable outcomes.

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Extrinsic outflow graft obstruction of the HeartMate 3 LVAD: A state-of-the-art review

Goldstein,

Kanwar,

Cowger

et al. 2024

The Journal of Heart and Lung Transplantation

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Percutaneous Management of Outflow Graft Obstruction in Patients With Continuous Flow Left Ventricular Assist Devices

Cited by 5 publications

References 5 publications

Acute Left Ventricular Assist Device Failure From Outflow Graft Dissection Flap Successfully Treated With Stent Placement

Acute Left Ventricular Assist Device Failure From Outflow Graft Dissection Flap Successfully Treated With Stent Placement

A Redo Percutaneous Emergency Intervention of Left Ventricular Assist Device Graft Occlusion

Extrinsic outflow graft obstruction of the HeartMate 3 LVAD: A state-of-the-art review

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