From the Center for Advanced Heart Failure, McGovern Medical School, University of Texas Health Science Center at Houston/Memorial Hermann Hospital-Texas Medical Center, Houston, Texas.
ASAIO J. 2021 Jun 1;67(6):e107-e109. doi: 10.1097/MAT.0000000000001266.
Left ventricular assist devices (LVADs) implanted into patients with heart failure sometimes develop insufficient forward flow due to malfunction of the outflow graft. One increasingly seen source of outflow graft malfunction is the development of external compression of the outflow graft (ECOG) due to the accumulation of material between the flexible outflow graft and the relatively rigid overlying Gore-Tex tubular graft. When there is segmental ECOG, a percutaneous approach with outflow graft stent placement is the treatment of choice. However, we have encountered cases with diffuse ECOG for which surgery appeared to be a superior choice. We, therefore, developed a minimally invasive surgical approach in which a mini-thoracotomy, rather than redo-sternotomy, is combined with unroofing of the Gore-Tex graft and subsequent evacuation of the organized hematoma. We describe this technique in two patients with diffuse ECOG in whom we found the method to be simple, relatively rapid, and very effective.
左心室辅助装置（LVAD）植入心力衰竭患者后，有时会因流出道移植物故障而导致前向血流不足。流出道移植物故障的一个越来越常见的原因是由于柔性流出道移植物和相对刚性的戈尔管状移植物之间的材料积聚，导致流出道移植物外部压缩（ECOG）的发展。当存在节段性 ECOG 时，经皮方法进行流出道移植物支架置入是首选治疗方法。然而，我们遇到了一些弥漫性 ECOG 的病例，对于这些病例，手术似乎是更好的选择。因此，我们开发了一种微创外科方法，该方法采用小开胸术，而不是重新胸骨切开术，结合戈尔管状移植物的开盖和随后清除已形成的血肿。我们在两名弥漫性 ECOG 患者中描述了该技术，我们发现该方法简单、相对快速且非常有效。
