Micek Laurin, Schibilsky David, Kroll Johannes, Eschenhagen Matthias, Berchtold-Herz Michael, Maier Sven, Neudorf Simon, Czerny Martin
Department for Cardiovascular Surgery, University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany.
Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany.
Eur J Cardiothorac Surg. 2025 Mar 28;67(4). doi: 10.1093/ejcts/ezaf089.
Left ventricular assist device (LVAD) outflow graft obstruction (OGO) is a serious complication that often requires surgical intervention. Standard approaches involve cardiopulmonary bypass (CPB) or veno-arterial extracorporeal membrane oxygenation (vaECMO) to facilitate outflow graft clamping and shortening. We present a surgical approach to reduce the need for CPB or vaECMO for outflow graft shortening. A 25-year-old female presented for routine LVAD follow-up with reduced device flow. Computed tomography angiography revealed outflow graft obstruction due to external compression from accumulated material between the outflow graft and the bend relief, along with graft elongation. To correct this, we performed outflow graft revision and shortening using a Dacron prosthesis as a bypass from the proximal to the distal outflow graft, avoiding CPB or vaECMO. LVAD flow was immediately restored postoperatively, and the patient recovered without complications. Follow-up computed tomography angiography confirmed full resolution of the obstruction with no recurrence. Managing LVAD outflow graft obstruction is particularly challenging when accompanied by elongation. The basket-handle technique offers a safe and effective alternative to traditional methods, allowing for outflow graft shortening without CPB or vaECMO, thereby reducing procedural risks and promoting faster patient recovery.
左心室辅助装置（LVAD）流出道移植物梗阻（OGO）是一种严重并发症，常需手术干预。标准方法包括体外循环（CPB）或静脉-动脉体外膜肺氧合（vaECMO），以利于流出道移植物夹闭和缩短。我们提出一种手术方法，以减少CPB或vaECMO用于流出道移植物缩短的需求。一名25岁女性因LVAD流量降低前来进行常规随访。计算机断层血管造影显示，由于流出道移植物与弯曲缓解装置之间积聚的物质产生外部压迫，以及移植物伸长，导致流出道移植物梗阻。为纠正此情况，我们使用涤纶人工血管作为从近端到远端流出道移植物的旁路，进行流出道移植物修复和缩短，避免使用CPB或vaECMO。术后LVAD流量立即恢复，患者康复且无并发症。随访计算机断层血管造影证实梗阻完全解除且无复发。当伴有伸长时，处理LVAD流出道移植物梗阻尤其具有挑战性。篮柄技术为传统方法提供了一种安全有效的替代方案，可在不使用CPB或vaECMO的情况下实现流出道移植物缩短，从而降低手术风险并促进患者更快康复。
