Assi Milwidsky1,2, Miguel Alvarez Villela1, Jose Wiley1, Cristina Sanina1, Snehal R Patel1, Nicole Sutton3, Azeem Latib1, Daniel B Sims1, Stephen J Forest4, Julia J Shin1, Muhammad U Farooq1, Daniel J Goldstein4, Ulrich P Jorde1. 1. Division of Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA. 2. Division of Cardiology Tel-Aviv Medical Center affiliated with Sackler School of Medicine in Tel-Aviv University, New York, New York, USA. 3. Division of Pediatric Cardiology, Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA. 4. Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA.
Abstract
BACKGROUND: The use of the HeartMate 3 (HM3) left ventricular assist device (LVAD) is expanding. Despite being associated with lower rates of adverse events and increased survival, outflow graft obstruction (OGO) has been reported in patients with HM3. The incidence and best management of this serious complication remain unclear. METHODS: We describe six cases of HM3 OGO occurring in five patients in our institutional HM3 cohort. Four cases underwent computed tomography angiography and in two percutaneous angiography was directly performed to confirm the diagnosis. In four cases, percutaneous repair of the OG was performed using common interventional cardiology (IC) techniques. RESULTS: Our institutional incidence of OGO was 7% (event rate of 0.05 per patient year); much higher than the previously reported incidence of 1.6%. All cases occurred in the bend relief covered segment. Only two patients had apparent OG twisting, and in two, OGO occurred despite placement of an anti-twist clip at the time of implant. External compression seems to play a role in most cases. Balloon "graftoplasty" and stent deployment via the femoral artery alleviated the obstruction and normalized LVAD flow in all patients who underwent percutaneous repair. The use of self-expanding stents allowed for downsizing of the procedural access site to 10 Fr. No serious procedure-related complications occurred. CONCLUSION: OGO is common in HM3 patients, external compression due to biomaterial accumulated surrounding the OG is a common etiology. Percutaneous repair using standard IC techniques is safe and feasible in cases of compression with or without partial twisting.
BACKGROUND: The use of the HeartMate 3 (HM3) left ventricular assist device (LVAD) is expanding. Despite being associated with lower rates of adverse events and increased survival, outflow graft obstruction (OGO) has been reported in patients with HM3. The incidence and best management of this serious complication remain unclear. METHODS: We describe six cases of HM3 OGO occurring in five patients in our institutional HM3 cohort. Four cases underwent computed tomography angiography and in two percutaneous angiography was directly performed to confirm the diagnosis. In four cases, percutaneous repair of the OG was performed using common interventional cardiology (IC) techniques. RESULTS: Our institutional incidence of OGO was 7% (event rate of 0.05 per patient year); much higher than the previously reported incidence of 1.6%. All cases occurred in the bend relief covered segment. Only two patients had apparent OG twisting, and in two, OGO occurred despite placement of an anti-twist clip at the time of implant. External compression seems to play a role in most cases. Balloon "graftoplasty" and stent deployment via the femoral artery alleviated the obstruction and normalized LVAD flow in all patients who underwent percutaneous repair. The use of self-expanding stents allowed for downsizing of the procedural access site to 10 Fr. No serious procedure-related complications occurred. CONCLUSION: OGO is common in HM3 patients, external compression due to biomaterial accumulated surrounding the OG is a common etiology. Percutaneous repair using standard IC techniques is safe and feasible in cases of compression with or without partial twisting.
Authors: Rocco Edoardo Stio; Marina Comisso; Luca Paolucci; Silvio Coletta; Vincenzo Cesario; Michele Gioia; Marco Stefano Nazzaro; Guglielmo Saitto; Carlo Contento; Emilio D'Avino; Francesco De Felice; Domenico Gabrielli; Francesco Musumeci Journal: Int J Environ Res Public Health Date: 2022-05-14 Impact factor: 4.614
Authors: Rocco Edoardo Stio; Andrea Montalto; Alfredo Intorcia; Vincenzo Polizzi; Mariano Feccia; Carmine Musto; Mauro Pennacchi; Luca Paolucci; Regina Stumpo; Emilio D'Avino; Francesco De Felice; Domenico Gabrielli; Francesco Musumeci Journal: Int J Environ Res Public Health Date: 2022-02-20 Impact factor: 3.390