Ajello Silvia, Pieri Marina, Bertoglio Luca, Altizio Savino, Nardelli Pasquale, Scandroglio Anna Mara
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Department of Vascular Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Artif Organs. 2023 Apr;47(4):786-790. doi: 10.1111/aor.14450. Epub 2022 Nov 17.
Blood flow obstruction at the level of the outflow graft is a rare but severe complication of LVAD support. We present a series of five patients supported with HeartMate3 LVAD (Abbott Labs, Chicago, IL) that developed an outflow graft obstruction after 607-1250 days of support, during prolonged antithrombotic therapy. Three patients presented with severe symptoms of heart failure, were treated with endovascular stenting and experienced full recovery. Preoperative computed tomography angiography and intraoperative angiography together with intravascular ultrasound provided diagnosis and guided treatment. In two patients, outflow obstruction was an occasional finding at imaging without heart failure symptoms and a "watchful waiting" approach was adopted: delayed treatment in one of them was futile. This late adverse event is peculiar for its pathophysiology and not yet discussed among the mechanical circulatory support community.
流出道移植物水平的血流阻塞是左心室辅助装置（LVAD）支持的一种罕见但严重的并发症。我们报告了一组五例接受HeartMate3 LVAD（雅培实验室，伊利诺伊州芝加哥）支持的患者，他们在接受延长的抗血栓治疗607 - 1250天期间出现了流出道移植物阻塞。三名患者出现严重心力衰竭症状，接受了血管内支架置入治疗并完全康复。术前计算机断层扫描血管造影、术中血管造影以及血管内超声共同提供了诊断并指导了治疗。在两名患者中，流出道阻塞是在影像学检查中偶然发现的，没有心力衰竭症状，因此采取了“观察等待”的方法：其中一名患者延迟治疗是徒劳的。这种晚期不良事件因其病理生理学特点而独特，机械循环支持领域尚未对此进行讨论。
