Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
The Lawrenceville School, Lawrenceville, New Jersey, USA.
Artif Organs. 2024 Jun;48(6):577-585. doi: 10.1111/aor.14736. Epub 2024 Apr 5.
LVAD outflow graft stenosis continues to remain prevalent with a high complication rate. We sought to pool the existing evidence on indications, utilization patterns, and outcomes of transcatheter interventions for outflow graft stenosis in the HeartMate 3 LVAD.
An electronic search was performed to identify all studies in the English literature reporting on HeartMate 3 LVAD outflow graft stenting. Patient-level data were extracted for analysis.
Thirteen published reports and one unpublished case comprising a total of 28 patients were included. Median patient age was 68.5 years [Interquartile range: 58, 71] and 25.9% (7/27) were female. Dyspnea [60.7% (17/28)] was the most common presenting symptom. Low flow alarms were present in 60% (15/25) of patients. Findings included external compression [35.7% (10/28)], graft twist [21.4% (6/28)], graft twist and external compression [14.3% (4.28)], intraluminal thrombus [10.7% (3/28)], graft twist and intraluminal thrombus [3.6% (1/28)], and pseudoaneurysm of outflow graft [3.6% (1/28)]. Median time from LVAD implantation to stenting was 2.1 years [1.4, 3]. Immediate flow normalization after stenting was observed in 85.7% (24/28). The 30-day mortality was 12% (3/25). Overall mortality was 12% (3/25) at a median follow-up of 3.9 months [1, 17].
Outflow graft stenting in the HeartMate 3 LVAD appears to be a reasonable treatment option for outflow graft stenosis, with low overall rates of complications and mortality. Further refinement of indications and approaches may improve outcomes.
左心室辅助装置（LVAD）流出道移植物狭窄仍然很常见，且并发症发生率较高。我们旨在汇总 HeartMate 3 LVAD 流出道移植物狭窄经导管介入治疗的适应证、使用模式和结局的现有证据。
我们进行了电子检索，以确定所有报道 HeartMate 3 LVAD 流出道移植物支架置入术的英文文献中的研究。提取患者水平数据进行分析。
共纳入 13 篇已发表的报告和 1 篇未发表的病例报告，总计 28 例患者。中位患者年龄为 68.5 岁[四分位距：58，71]，25.9%（7/27）为女性。最常见的首发症状为呼吸困难[60.7%（17/28）]。60%（15/25）的患者存在低流量报警。发现包括外部压迫[35.7%（28/28）]、移植物扭曲[21.4%（6/28）]、移植物扭曲伴外部压迫[14.3%（4/28）]、腔内血栓[10.7%（3/28）]、移植物扭曲伴腔内血栓[3.6%（1/28）]和流出道移植物假性动脉瘤[3.6%（1/28）]。从 LVAD 植入到支架置入的中位时间为 2.1 年[1.4，3]。支架置入后即刻血流恢复正常率为 85.7%（24/28）。30 天死亡率为 12%（3/25）。中位随访 3.9 个月[1，17]时，总体死亡率为 12%（3/25）。
HeartMate 3 LVAD 流出道移植物支架置入术似乎是流出道移植物狭窄的一种合理治疗选择，并发症和死亡率总体较低。进一步细化适应证和方法可能会改善结局。
