Stenting of outflow graft obstruction after left ventricular assist device implantation

Left ventricular assist devices (LVADs) have revolutionised the treatment of patients with advanced heart failure (HF). Ongoing engineering advances in LVAD design have markedly improved survival and quality of life. However, potentially life-threatening long-term complications have been observed, even with the HeartMate 3 (HM3 [Abbott]) LVAD. One of these is outflow graft obstruction (OGO), which is known to have different aetiologies and clinical presentations [1].

In this single-centre experience from a large tertiary care centre, we report detection principles and interventional treatment of OGO within the portion covered by the bend relief in patients on HM3. Between January 2015 and April 2023, 433 patients underwent LVAD implantation at our institution. In all cases, the outflow graft (OG) was connected to the ascending aorta and placed alongside the right ventricle; it was not wrapped in protective material. All patients were followed up until October 2023. Written informed consent for data collection was given by all patients.

We established a standardised diagnostic algorithm to confirm OGO (Figure 1). OGO was defined as external compression of the OG lumen due to the accumulation...