Division of Interventional Cardiology, Department of Heart and Vessels, San Camillo-Forlanini Hospital, 00152 Rome, Italy.
Cardiac Surgery Unit and Heart Transplantation Center, Department of Heart and Vessels, San Camillo-Forlanini Hospital, 00152 Rome, Italy.
Int J Environ Res Public Health. 2022 Feb 20;19(4):2441. doi: 10.3390/ijerph19042441.
Left ventricular assist device (LVAD) obstruction can be a dramatic and life-threatening complication in patients with advanced heart failure (HF). Despite surgical redo is often required in these patients, it is associated with a high risk of periprocedural negative outcome. We report the case of a 68-year-old male with a thrombotic stenosis of the LVAD proximal outflow-graft. Following Heart Team debate, a percutaneous intervention was planned during veno-arterial Extra Corporeal Membrane Oxygenation (ECMO) assistance. To achieve the needed catheter support, we used the "distal balloon anchoring technique" through the outflow-graft and managed to implant a covered stent, rapidly restoring the flow through the LVAD. The patient was discharged without further complications. Our case shows that, in selected cases, percutaneous treatment of LVAD obstructions can be feasible, especially using advanced techniques derived from the experiences in coronary interventions and under ECMO assistance. More cases and prospective studies are mostly needed to explore long-term patency of the LVADs and clinical outcomes in these high-risk patients.
左心室辅助装置（LVAD）阻塞在晚期心力衰竭（HF）患者中可能是一种戏剧性且危及生命的并发症。尽管这些患者通常需要进行外科翻修，但围手术期的负面结果风险很高。我们报告了一例 68 岁男性 LVAD 近端流出移植物血栓性狭窄的病例。在心脏团队进行辩论后，计划在静脉-动脉体外膜肺氧合（ECMO）辅助下进行经皮介入治疗。为了获得所需的导管支持，我们通过流出移植物使用了“远端球囊锚定技术”，并成功植入了覆盖支架，迅速恢复了 LVAD 的血流。患者无进一步并发症出院。我们的病例表明，在选定的情况下，LVAD 阻塞的经皮治疗可能是可行的，尤其是在 ECMO 辅助下，使用源自冠状动脉介入治疗经验的先进技术。需要更多的病例和前瞻性研究来探索这些高危患者的 LVAD 长期通畅率和临床结果。
