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Shahbahrami K, Lee CY, Tsukashita M. Mycotic Left Ventricular Apical Pseudoaneurysm Following HM3 Left Ventricular Assist Device Implantation. Circ Cardiovasc Imaging 2023; 16:e014278. [PMID: 36649448 DOI: 10.1161/circimaging.122.014278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Kevin Shahbahrami
- Department of Cardiothoracic Surgery, Allegheny General Hospital, Pittsburgh, PA
| | - Candice Y Lee
- Department of Cardiothoracic Surgery, Allegheny General Hospital, Pittsburgh, PA
| | - Masaki Tsukashita
- Department of Cardiothoracic Surgery, Allegheny General Hospital, Pittsburgh, PA
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2
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Dreessens E, Cox J, Ramsey J, Uyeda E, Adamson R, Jaski B, Narula A. Transaxillary Stenting of LVAD Outflow Graft Obstruction. JACC Case Rep 2021; 3:1064-1068. [PMID: 34317685 PMCID: PMC8311358 DOI: 10.1016/j.jaccas.2021.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/04/2021] [Accepted: 02/16/2021] [Indexed: 11/12/2022]
Abstract
An 82-year-old man with a HeartMate II left ventricular assist device presented with low-flow alarms and cardiogenic shock secondary to left ventricular assist device outflow graft obstruction. Given high risk for redo sternotomy, the heart team decided on percutaneous intervention with peripheral stents, a procedure that is currently limited to case reports. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Erin Dreessens
- Naval Medical Center San Diego, San Diego, California, USA
| | - Justin Cox
- Naval Medical Center San Diego, San Diego, California, USA.,Sharp Memorial Hospital, San Diego, California, USA
| | - Jack Ramsey
- Sharp Memorial Hospital, San Diego, California, USA
| | - Ensley Uyeda
- Sharp Memorial Hospital, San Diego, California, USA
| | | | - Brian Jaski
- Sharp Memorial Hospital, San Diego, California, USA
| | - Arvin Narula
- Sharp Memorial Hospital, San Diego, California, USA
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Balceniuk MD, Ziazadeh D, Mix DS, Prasad S, Stoner MC. Totally percutaneous endovascular repair of HeartMate 3 ventricular assistive device outflow graft pseudoaneurysm. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:505-508. [PMID: 33134631 PMCID: PMC7588804 DOI: 10.1016/j.jvscit.2020.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/05/2020] [Indexed: 11/19/2022]
Abstract
The rate of heart failure and subsequent placement of left ventricular assistive devices (LVADs) has been increasing. The extra-anatomic placement of the LVAD and outflow graft presents a challenging problem for repair when complications arise. The present report describes a case of a 63-year-old man who had presented with acute pseudoaneurysm of the outflow graft of his recently placed LVAD. Percutaneous access of the left subclavian artery and percutaneous, transthoracic access of the outflow graft was obtained to allow for sheath placement and stent deployment within the outflow graft. The patient underwent successful endovascular repair of the defect without complications.
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Affiliation(s)
- Mark D. Balceniuk
- Division of Vascular Surgery, University of Rochester Medical Center, Rochester, NY
| | - Daniel Ziazadeh
- Division of Cardiac Surgery, University of Rochester Medical Center, Rochester, NY
| | - Doran S. Mix
- Division of Vascular Surgery, University of Rochester Medical Center, Rochester, NY
| | - Sunil Prasad
- Division of Cardiac Surgery, University of Rochester Medical Center, Rochester, NY
| | - Michael C. Stoner
- Division of Vascular Surgery, University of Rochester Medical Center, Rochester, NY
- Correspondence: Michael C. Stoner, MD, Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, 601 Elmwood Ave, Box 652, Rochester, NY 14642
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Teman NR, Shah SM, Downs E, Ailawadi G, Mazimba S, Fritz Angle J, Khaja MS, Yarboro LT. Endovascular repair of left ventricular assist device outflow graft defect. J Card Surg 2020; 35:3235-3238. [PMID: 32970354 DOI: 10.1111/jocs.15005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/18/2020] [Accepted: 08/11/2020] [Indexed: 11/29/2022]
Abstract
Outflow graft complications after left ventricular assist device placement are infrequent but highly morbid. In this case report, we describe endovascular repair of multiple outflow graft defects with external hemorrhage in a complex patient using overlapping stent grafts. This approach successfully stopped the outflow graft hemorrhage and temporized the patient for subsequent cardiac transplantation.
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Affiliation(s)
- Nicholas R Teman
- Division of Cardiac Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Shawn M Shah
- Division of Cardiac Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Emily Downs
- Division of Cardiac Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Gorav Ailawadi
- Division of Cardiac Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Sula Mazimba
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - John Fritz Angle
- Division of Vascular and Interventional Radiology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Minhaj S Khaja
- Division of Vascular and Interventional Radiology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Leora T Yarboro
- Division of Cardiac Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
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5
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Left Ventricular Assist Device Outflow Graft Obstruction: A Complication Specific to Polytetrafluoroethylene Covering. A Word of Caution! ASAIO J 2020; 65:e58-e62. [PMID: 30575627 DOI: 10.1097/mat.0000000000000929] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Pump thrombosis is an established complication of left ventricular assist devices (LVADs). Outflow graft obstruction has been previously described as one cause of LVAD thrombosis. We identified four cases of outflow graft obstruction that were attributed to a commonly applied polytetrafluoroethylene (PTFE) covering of the outflow graft. In this set of patients, the outflow graft was obstructed by a thrombus which formed between the outflow graft and its external PTFE covering, leading to impingement of the outflow graft. Patients typically presented after a median duration of 26 months (range 23-41 months) of support with gradual increase of heart failure symptoms and low pump flows. Computed tomography angiography was found to be the best diagnostic modality. Treatments included surgical LVAD replacement as well as percutaneous intraluminal stenting of the outflow graft. Our findings indicate that PTFE graft covering of the LVAD outflow graft can lead to graft occlusion and should be reconsidered as a potentially harmful modification to the approved device implant technique.
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Pya Y, Mussayev A, Alimbayev S, Medressova A, Bekbossynov S, Andossova S, Khissamutdinov N, Jetybayeva S, la Fleur P. Left Ventricular Assist Device Outflow Graft Pseudoaneurysm Treated with Covered Balloon Expandable Stent. ASAIO J 2019; 66:e74-e76. [PMID: 31192842 DOI: 10.1097/mat.0000000000001033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Left ventricular assist device (LVAD) outflow graft injury is a very rare complication after LVAD implantation and is usually treated surgically. This is a case report of successful stenting of the damaged outflow graft 2.5 years after LVAD implantation, followed by successful heart transplantation.
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Affiliation(s)
- Yuriy Pya
- From the National Research Cardiac Surgery Center, Nur-Sultan (Astana), Kazakhstan
| | | | - Serik Alimbayev
- Department of Interventional cardiology, Nur-Sultan (Astana), Kazakhstan
| | | | | | | | | | | | - Philip la Fleur
- Nazarbayev University School of Medicine, Nur-Sultan (Astana), Kazakhstan
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Trankle CR, Quader MA, Grizzard JD, Tang DG, Shah KB, Paris K, Shepard CK, Gertz ZM. Internal Versus External Compression of a Left Ventricular Assist Device Outflow Graft. Circ Heart Fail 2018; 11:e004959. [DOI: 10.1161/circheartfailure.118.004959] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - John D. Grizzard
- Pauley Heart Center and Department of Radiology (J.D.G.), Virginia Commonwealth University, Richmond
| | - Daniel G. Tang
- and Division of Cardiothoracic Surgery (M.A.Q., D.G.T., C.K.S.)
| | - Keyur B. Shah
- Division of Cardiology (C.R.T., K.B.S., K.P., Z.M.G.)
| | - Kendall Paris
- Division of Cardiology (C.R.T., K.B.S., K.P., Z.M.G.)
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9
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Endovascular repair of ventricular assist device outflow cannula stenosis. Catheter Cardiovasc Interv 2016; 91:E81-E85. [DOI: 10.1002/ccd.26852] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 07/15/2016] [Accepted: 10/12/2016] [Indexed: 11/07/2022]
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Cho SH, Fritz T, Khaghani A. Traumatic pseudoaneurysm resulting from ruptured outflow graft due to disconnection of HeartMate II LVAD Bend Relief. J Cardiol Cases 2016; 13:178-180. [PMID: 30546640 DOI: 10.1016/j.jccase.2016.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 01/26/2016] [Accepted: 02/01/2016] [Indexed: 11/29/2022] Open
Abstract
We report a rare case of a 59-year-old male who presented with a pulsating pseudoaneurysm 15 months after placement of a HeartMate II left ventricular assist device (Thoratec Corporation, Pleasanton, CA, USA). Computed tomography and echocardiogram imaging and surgical exploration revealed that bend relief spontaneously detached from the outflow conduit, and the sharp edges of the snap ring component of the bend relief caused perforation to the outflow graft. <Learning objective: Left ventricular assist devices (LVADs) are of growing popularity within the field of cardiology as a means of bridge to transplant and as a destination therapy. This case highlights a rare, but potentially fatal complication of a popular LVAD, the HeartMate II. Since this case report, the US Food and Drug Administration has released a statement of this particular complication, and Thoratec has made changes to the design. However, many patients still have the older model in place, and are at risk of this rare but potentially fatal complication.>.
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Affiliation(s)
| | - Timothy Fritz
- Spectrum Health Frederik Meijer Heart & Vascular Institute, Grand Rapids, MI, USA
| | - Asghar Khaghani
- Spectrum Health Frederik Meijer Heart & Vascular Institute, Grand Rapids, MI, USA
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Mallidi HR, Anand J, Singh SK. Long-term mechanical circulatory support: A new disease state? J Thorac Cardiovasc Surg 2015; 150:e13-4. [DOI: 10.1016/j.jtcvs.2015.04.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 04/17/2015] [Indexed: 11/30/2022]
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Abraham J, Remick JD, Caulfield T, Puhlman M, Evenson K, Ott G, Kirker E. Left Ventricular Assist Device Outflow Cannula Obstruction Treated With Percutaneous Endovascular Stenting. Circ Heart Fail 2015; 8:229-30. [DOI: 10.1161/circheartfailure.114.001891] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jacob Abraham
- From the Providence Heart and Vascular Institute, Portland, OR
| | | | - Todd Caulfield
- From the Providence Heart and Vascular Institute, Portland, OR
| | - Mark Puhlman
- From the Providence Heart and Vascular Institute, Portland, OR
| | - Kathryn Evenson
- From the Providence Heart and Vascular Institute, Portland, OR
| | - Gary Ott
- From the Providence Heart and Vascular Institute, Portland, OR
| | - Eric Kirker
- From the Providence Heart and Vascular Institute, Portland, OR
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13
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Dhesi P, Sadiq I, Gluck J. Endovascular repair of a HeartMate II left ventricular assist device. J Heart Lung Transplant 2014; 33:1198-9. [PMID: 25438164 DOI: 10.1016/j.healun.2014.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 08/22/2014] [Accepted: 09/03/2014] [Indexed: 10/24/2022] Open
Affiliation(s)
- Pavittarpaul Dhesi
- Division of Cardiology, Department of Medicine, University of Connecticut, Farmington, Connecticut
| | - Immad Sadiq
- Division of Cardiology, Department of Medicine, University of Connecticut, Farmington, Connecticut; Division of Cardiology, Henry Low Heart Center, Hartford Hospital, Hartford, Connecticut
| | - Jason Gluck
- Division of Cardiology, Department of Medicine, University of Connecticut, Farmington, Connecticut; Division of Cardiology, Henry Low Heart Center, Hartford Hospital, Hartford, Connecticut
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Partyka C, Taylor B. Review article: Ventricular assist devices in the emergency department. Emerg Med Australas 2014; 26:104-12. [DOI: 10.1111/1742-6723.12171] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Christopher Partyka
- Department of Emergency Medicine; Liverpool Hospital; Sydney New South Wales Australia
| | - Ben Taylor
- Department of Emergency Medicine; Liverpool Hospital; Sydney New South Wales Australia
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