Diagnosis and Treatment Strategies of Outflow Graft Obstruction of the Fully Magnetically Levitated Continuous Flow Centrifugal Left Ventricular Assist Device

Objectives: Left ventricular assist devices (LVAD) outflow graft compression is seen rarely and can present clinically subtle. A correct diagnosis is crucial for optimal treatment to ultimately avoid bail-out by (urgent) heart transplantation or unwarranted pump stop with subsequent exchange.

Methods: We present seven cases of outflow graft compression in patients (71% male, mean age 59,5 years, 3 patients with ICM, four patients with DCM) on fully magnetically levitated continuous flow centrifugal left ventricular assist device occurred between 648 and 1,222 days of support. Three patients presented with low-flow alarms, two asymptomatic patients were discovered during routine outpatient appointments. Detection principles like transthoracic echocardiography, LVAD log file analysis, CT scan and percutaneous angiography are described. Advantages and disadvantages of treatment strategies including stent implantation, surgery and in special cases watchful waiting are discussed.

Result: Three patients were successfully treated with stent implantation, two were surgically revised, one patient died and one patient without symptoms was listed for high urgent heart transplantation (survival 86%). Except for one patient with prolonged wound healing no complications occurred.

Conclusion: Obstruction of blood flow through the pump is a potentially life-threatening complication in patients treated with a left ventricular assist device. Outflow graft obstruction is a rare but severe complication whose clinical presentation may be subtle. Different therapeutic options exist and should be tailored to every patient.

Publication History

Article published online:
19 February 2021