From the Department of Cardiopulmonary Therapies and Transplantation, Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital - Texas Medical Center, Houston, Texas.
Department of Internal Medicine, Division of Cardiovascular Medicine, University of Texas Health Science Center at Houston/Memorial Hermann Hospital - Texas Medical Center, Houston, Texas.
ASAIO J. 2020 Jun;66(6):657-662. doi: 10.1097/MAT.0000000000001060.
Dysfunction of different components within continuous-flow (CF) left ventricular assist device (LVAD) systems may cause adverse cardiovascular and end-organ sequelae. Outflow graft obstruction is a recognized type of LVAD component dysfunction. Ten patients were admitted and treated for LVAD outflow graft obstruction. Two of these patients subsequently developed recurrent outflow graft obstruction requiring reintervention; however, each reoccurrence was at a different site than the original obstruction. Thus, a total of 12 cases of obstruction were analyzed. The most common reasons for hospital admission were low flow LVAD alarms or decompensated heart failure. Presentation with outflow graft obstruction occurred an average of 3.0 years after LVAD implantation. Patients underwent echocardiographic evaluation at the time of admission. Left ventricular assist device component dysfunction was suspected based on echocardiographic findings, and follow-up contrast studies were used to establish the specific diagnosis of outflow graft stenosis. The majority of stenotic lesions (10/12) were treated percutaneously with balloon angioplasty and stenting with balloon-expandable endovascular prostheses. Postintervention, all patients had significant improvement in LVAD flow rates.
不同组件在连续流（CF）左心室辅助装置（LVAD）系统中的功能障碍可能导致不良的心血管和终末器官后果。流出道移植物阻塞是一种公认的 LVAD 组件功能障碍类型。有 10 名患者因 LVAD 流出道移植物阻塞而入院治疗。其中 2 名患者随后出现复发性流出道移植物阻塞，需要再次介入治疗；然而，每次复发的部位都与最初的阻塞部位不同。因此，共分析了 12 例阻塞。住院的最常见原因是 LVAD 低流量报警或心力衰竭失代偿。在 LVAD 植入后平均 3.0 年出现流出道移植物阻塞。患者在入院时接受了超声心动图评估。根据超声心动图结果怀疑 LVAD 组件功能障碍，并进行了随访对比研究以确定流出道狭窄的具体诊断。大多数狭窄病变（10/12）采用经皮球囊血管成形术和球囊扩张血管内支架治疗。介入治疗后，所有患者的 LVAD 流速均有显著改善。
