An innovative approach to treat left ventricular assist device outflow graft obstruction-the basket-handle technique†.

Abstract

Left ventricular assist device (LVAD) outflow graft obstruction (OGO) is a serious complication that often requires surgical intervention. Standard approaches involve cardiopulmonary bypass (CPB) or veno-arterial extracorporeal membrane oxygenation (vaECMO) to facilitate outflow graft clamping and shortening. We present a surgical approach to reduce the need for CPB or vaECMO for outflow graft shortening. A 25-year-old female presented for routine LVAD follow-up with reduced device flow. Computed tomography angiography revealed outflow graft obstruction due to external compression from accumulated material between the outflow graft and the bend relief, along with graft elongation. To correct this, we performed outflow graft revision and shortening using a Dacron prosthesis as a bypass from the proximal to the distal outflow graft, avoiding CPB or vaECMO. LVAD flow was immediately restored postoperatively, and the patient recovered without complications. Follow-up computed tomography angiography confirmed full resolution of the obstruction with no recurrence. Managing LVAD outflow graft obstruction is particularly challenging when accompanied by elongation. The basket-handle technique offers a safe and effective alternative to traditional methods, allowing for outflow graft shortening without CPB or vaECMO, thereby reducing procedural risks and promoting faster patient recovery.