Gittess David, Al-Ani Mohammad A, Stein Andrew, Vilaro Juan R, Parker Alex M, Aranda Juan M, Ahmed Mustafa M, Jeng Eric, Anderson R David
Division of Internal Medicine, University of Florida, Gainesville, Florida.
Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida.
JHLT Open. 2025 Feb 20;8:100235. doi: 10.1016/j.jhlto.2025.100235. eCollection 2025 May.
Left ventricular assist devices (LVADs) have demonstrated a significant mortality and quality-of-life benefit to patients with end-stage heart failure. However, a unique potential complication is outflow graft obstruction (OGO), in which the conduit between the LVAD pump and the aorta is narrowed. Recently, attempts at an endovascular approach with outflow graft stenting have been successful with comparatively low risk relative to surgical replacement of the LVAD. Because of the rarity of this event, optimal stenting technique and periprocedural management are unclear.
In this series of 10 patients, we detail the percutaneous endovascular approach to OGO treatment. All cases were confirmed with contrasted computed tomography.
One patient experienced OGO recurrence and one patient had 2 recurrences, making the total interventions analyzed 13. The obstructions were either intrinsic, with accumulation of biodebris between the graft and the outer bend relief in 9 patients, or extrinsic from outflow graft kinking in 4 patients. All patients underwent successful outflow graft stenting confirmed by rapid restoration of pre-obstruction flow (12/13) or elimination of a pressure gradient across a site of suspected obstruction (1/13). Recurrence was observed in 3 instances. We further describe the stenting technique employed and how the unique nature of OGOs impacts the endovascular approach, and post-procedural outcomes.
左心室辅助装置（LVAD）已证明对终末期心力衰竭患者具有显著的降低死亡率和改善生活质量的益处。然而，一种独特的潜在并发症是流出道移植物梗阻（OGO），即LVAD泵与主动脉之间的管道变窄。最近，采用流出道移植物支架置入术的血管内治疗方法已取得成功，相对于LVAD的手术置换，其风险相对较低。由于该事件罕见，最佳的支架置入技术和围手术期管理尚不清楚。
在这组10例患者中，我们详细介绍了经皮血管内治疗OGO的方法。所有病例均经对比计算机断层扫描确诊。
1例患者出现OGO复发，1例患者复发2次，因此共分析了13次干预措施。梗阻原因要么是内在的，9例患者的移植物与外弯减压处之间存在生物碎屑堆积；要么是外在的，4例患者因流出道移植物扭结。所有患者均成功进行了流出道移植物支架置入术，这通过梗阻前血流迅速恢复（12/13）或消除疑似梗阻部位的压力梯度（1/13）得以证实。观察到3例复发。我们进一步描述了所采用的支架置入技术，以及OGO的独特性质如何影响血管内治疗方法和术后结果。
