Advancing the frontier of left ventricular assist device outflow graft stenting: Stenting techniques and outcomes in a landmark case series

Background

Left ventricular assist devices (LVADs) have demonstrated a significant mortality and quality-of-life benefit to patients with end-stage heart failure. However, a unique potential complication is outflow graft obstruction (OGO), in which the conduit between the LVAD pump and the aorta is narrowed. Recently, attempts at an endovascular approach with outflow graft stenting have been successful with comparatively low risk relative to surgical replacement of the LVAD. Because of the rarity of this event, optimal stenting technique and periprocedural management are unclear.

Methods

In this series of 10 patients, we detail the percutaneous endovascular approach to OGO treatment. All cases were confirmed with contrasted computed tomography.

Results

One patient experienced OGO recurrence and one patient had 2 recurrences, making the total interventions analyzed 13. The obstructions were either intrinsic, with accumulation of biodebris between the graft and the outer bend relief in 9 patients, or extrinsic from outflow graft kinking in 4 patients. All patients underwent successful outflow graft stenting confirmed by rapid restoration of pre-obstruction flow (12/13) or elimination of a pressure gradient across a site of suspected obstruction (1/13). Recurrence was observed in 3 instances. We further describe the stenting technique employed and how the unique nature of OGOs impacts the endovascular approach, and post-procedural outcomes.