Wallace Ryan, Rogers Toby, Slack Michael, Sheikh Farooq H, Balsara Keki, Weissman Gaby, Satler Lowell F, Waksman Ron, Ben-Dor Itsik
Department of Cardiology, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center/MedStar Georgetown University Hospital Center, Washington, DC, USA.
Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
Cardiovasc Revasc Med. 2025 Mar;72:34-37. doi: 10.1016/j.carrev.2024.05.017. Epub 2024 May 13.
Outflow graft obstruction (OGO) is an uncommon yet life-threatening complication in patients with left ventricular assist devices (LVADs). In this retrospective, single-center case series, we identify the baseline demographics and presenting features of patients who develop LVAD OGO and the procedural details and outcomes surrounding percutaneous endovascular intervention (PEI).
We conducted a retrospective review of patients with LVADs at our institution between January 2010 and February 2023 who developed OGO and were treated with PEI. Details of the PEI including procedure time, fluoroscopy time, contrast use, stent size, number of stents, change in gradient, and change in flow after intervention were collected.
A total of 12 patients who had 14 cases of OGO were identified from January 2010 to February 2023. The average age at presentation was 64.78 years. Nine of the 14 cases occurred in male patients. Eleven of the 14 cases occurred with Heartware devices (2 recurrences), 2 in Heartmate 2 and 1 in Heartmate 3. Notable procedural details include a mean procedure time of 90.86 min and mean contrast use of 162.5 mL. The initial gradient across the OGO was reduced by an average of 72 %, to a mean post-PEI of 11.57 mmHg. The average number of stents to achieve this gradient was around 2.08, with the most common stent diameter being 10 mm. Thirty-day mortality after PEI was 7 % (1/14) in this high-risk patient population.
In our single-center experience, PEI can be a safe and effective treatment for LVAD OGO.
流出道移植物梗阻（OGO）是左心室辅助装置（LVAD）患者中一种罕见但危及生命的并发症。在这个回顾性、单中心病例系列中，我们确定了发生LVAD OGO患者的基线人口统计学特征和临床表现，以及经皮血管腔内介入治疗（PEI）的操作细节和结果。
我们对2010年1月至2023年2月在我院接受LVAD治疗且发生OGO并接受PEI治疗的患者进行了回顾性研究。收集了PEI的详细信息，包括手术时间、透视时间、造影剂用量、支架尺寸、支架数量、干预后梯度变化和流量变化。
2010年1月至2023年2月共确定了12例患者发生14例OGO。就诊时的平均年龄为64.78岁。14例中有9例发生在男性患者中。14例中有11例发生在Heartware装置中（2例复发），2例发生在Heartmate 2中，1例发生在Heartmate 3中。值得注意的操作细节包括平均手术时间为90.86分钟，平均造影剂用量为162.5毫升。OGO两端的初始梯度平均降低了72%，PEI后的平均梯度为11.57毫米汞柱。达到该梯度的平均支架数量约为2.08个，最常见的支架直径为10毫米。在这个高危患者群体中，PEI后30天死亡率为7%（1/14）。
根据我们的单中心经验，PEI可以是治疗LVAD OGO的一种安全有效的方法。
