Lewis Katz School of Medicine, Temple University Hospital, Philadelphia, PA.
Icahn School of Medicine, Mount Sinai Hospital, New York, NY.
J Cardiothorac Vasc Anesth. 2024 Dec;38(12):3055-3064. doi: 10.1053/j.jvca.2024.07.055. Epub 2024 Aug 8.
Left ventricular assist device (LVAD) outflow graft obstruction can result in severe clinical deterioration. Underlying mechanisms may vary depending on the location. Outflow graft tamponade due to external compression can be under recognized. Management of this complication varies across institutions and a uniform approach has yet to be elucidated.
Report a single center experience with outflow graft tamponade in patients with LVAD with the purpose of developing an optimal algorithm for the diagnosis and treatment of LVAD-related outflow graft tamponade.
Retrospective chart review between July 2011 and July 2020. A total of 351 LVADs were implanted at our center, with outflow graft tamponade identified in 26 patients with LVAD. Fourteen (53.8%) had HeartMate II™, 8 (30.8%) had HeartMate3™ and 4 (15.4%) had HeartWare™. Individuals presented with heart failure symptoms, an audible precordial murmur and LVAD alarms after a median duration of 862 days of support (IQR 327 - 1455). Of the 26 patients, 15 (57.7%) underwent mini thoracotomy with outflow graft relief, 4 had percutaneous balloon dilatation and stenting, 2 were bridged directly to transplant and 1 had a pump exchange. No intervention was made on the remaining due to mild symptoms (n = 4).
Conclusions: Outflow graft tamponade is a form outflow graft obstruction with a variable presentation that can result in significant hemodynamic compromise. It is amenable to both surgical and percutaneous interventions that restore LVAD function.
左心室辅助装置（LVAD）流出道移植物阻塞可导致严重的临床恶化。潜在的机制可能因位置而异。由于外部压迫导致的流出道移植物填塞可能被低估。这种并发症的治疗方法因机构而异，尚未阐明统一的方法。
报告一家中心的 LVAD 患者流出道移植物填塞的经验，目的是为 LVAD 相关流出道移植物填塞的诊断和治疗制定最佳算法。
回顾 2011 年 7 月至 2020 年 7 月的病历。我们中心共植入 351 台 LVAD，其中 26 例 LVAD 患者发现流出道移植物填塞。14 例（53.8%）为 HeartMate II™，8 例（30.8%）为 HeartMate3™，4 例（15.4%）为 HeartWare™。在中位支持时间 862 天（IQR 327-1455）后，患者出现心力衰竭症状、心前区可闻及杂音和 LVAD 报警。26 例患者中，15 例行小开胸术解除流出道梗阻，4 例行经皮球囊扩张和支架置入术，2 例直接桥接移植，1 例行泵置换。由于症状轻微，其余 4 例未进行干预。
结论：流出道移植物填塞是一种流出道阻塞的形式，临床表现多样，可导致严重的血液动力学障碍。它适用于恢复 LVAD 功能的手术和经皮介入治疗。
