Outflow Graft Tamponade: An Underrecognized Cause of Obstruction

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia Pub Date : 2024-08-08 DOI:10.1053/j.jvca.2024.07.055

Estefania Oliveros MD MSc, Arjun Gupta MD MPH, Kiran Mahmood MD, Vinh Q. Chau MD, Javier Sanz MD, Barry Love MD, Anuradha Lala MD, Sean P. Pinney MD, Donna M. Mancini MD, Anelechi Anyanwu MD, Sumeet S. Mitter MD MSc, Noah Moss MD

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Abstract

Left ventricular assist device (LVAD) outflow graft obstruction can result in severe clinical deterioration. Underlying mechanisms may vary depending on the location. Outflow graft tamponade due to external compression can be under recognized. Management of this complication varies across institutions and a uniform approach has yet to be elucidated. Report a single center experience with outflow graft tamponade in patients with LVAD with the purpose of developing an optimal algorithm for the diagnosis and treatment of LVAD-related outflow graft tamponade. Retrospective chart review between July 2011 and July 2020. A total of 351 LVADs were implanted at our center, with outflow graft tamponade identified in 26 patients with LVAD. Fourteen (53.8%) had HeartMate II™, 8 (30.8%) had HeartMate3™ and 4 (15.4%) had HeartWare™. Individuals presented with heart failure symptoms, an audible precordial murmur and LVAD alarms after a median duration of 862 days of support (IQR 327 - 1455). Of the 26 patients, 15 (57.7%) underwent mini thoracotomy with outflow graft relief, 4 had percutaneous balloon dilatation and stenting, 2 were bridged directly to transplant and 1 had a pump exchange. No intervention was made on the remaining due to mild symptoms (n = 4). Conclusions: Outflow graft tamponade is a form outflow graft obstruction with a variable presentation that can result in significant hemodynamic compromise. It is amenable to both surgical and percutaneous interventions that restore LVAD function.

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气流导管填塞：未被充分认识的阻塞原因

左心室辅助装置（LVAD）流出移植阻塞可导致严重的临床恶化。其根本机制可能因部位而异。外部压迫导致的流出管移植物阻塞可能未得到充分认识。不同机构对这种并发症的处理方法不尽相同，统一的处理方法尚待阐明。报告单个中心对 LVAD 患者外流移植物填塞的经验，目的是为 LVAD 相关外流移植物填塞的诊断和治疗制定最佳算法。对 2011 年 7 月至 2020 年 7 月期间的病历进行回顾性分析。我们中心共植入了 351 台 LVAD，发现 26 名 LVAD 患者存在血流移植物阻塞。其中 14 人（53.8%）植入了 HeartMate II™，8 人（30.8%）植入了 HeartMate3™，4 人（15.4%）植入了 HeartWare™。中位支持时间为 862 天（IQR 327 - 1455），患者出现心衰症状、心前区杂音和 LVAD 警报。在这 26 名患者中，15 人（57.7%）接受了小型开胸手术，并进行了流出道移植物疏通，4 人进行了经皮球囊扩张和支架植入术，2 人直接进行了移植桥接，1 人进行了泵交换。其余患者（4 人）因症状轻微而未进行干预。结论流出道移植物阻塞是一种流出道移植物阻塞，表现不一，可导致严重的血流动力学损害。可通过手术和经皮介入治疗恢复 LVAD 功能。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of cardiothoracic and vascular anesthesia 医学-呼吸系统

CiteScore

4.80

自引率

17.90%

发文量

606

审稿时长

37 days

期刊介绍： The Journal of Cardiothoracic and Vascular Anesthesia is primarily aimed at anesthesiologists who deal with patients undergoing cardiac, thoracic or vascular surgical procedures. JCVA features a multidisciplinary approach, with contributions from cardiac, vascular and thoracic surgeons, cardiologists, and other related specialists. Emphasis is placed on rapid publication of clinically relevant material.