Complex stenting of an obstructed outflow graft of a heartmate 3 in an adult after a mustard procedure.

Ventricular assist devices, such as the HeartMate 3, are routinely used to support patents with failing ventricular function. However, extrinsic obstruction of the outflow graft has been identified as a complication associated with the HeartMate 3. We report a case of a patient with transposition of the great arteries (d-TGA), status post-Mustard procedure with severe systemic (right) ventricular dysfunction who developed extrinsic obstruction of theoutflow graft, 6 years after implant, leading to a significant reduction in HeartMate 3 flow. This patient required the placement of multiple stents to fully address the diffuse stenosis of the outflow graft. This case underscores the technical challenges involved in managing extrinsic obstruction of theoutflow graft in patients with this anatomy and highlights the importance of a tailored, multidisciplinary approach. It emphasises the need for careful planning around stent overlap, outflow graft angulation, and catheter and wire positioning in the context of complex anatomical and device-related interactions.