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Outflow Graft Narrowing of the HeartMate 3 Left Ventricular Assist Device.

Outflow Graft Narrowing of the HeartMate 3 Left Ventricular Assist Device. The Annals of thoracic surgery Jain, S. S., Clerkin, K. J., Anstey, D. E., Liu, Q., Fried, J. A., Raikhelkar, J., Griffin, J. M., Marshall, D., Colombo, P., Yuzefpolskaya, M., Topkara, V., Naka, Y., Takeda, K., Sayer, G., Uriel, N., Leb, J. 2022

Abstract

Outflow graft narrowing has been reported in patients with the HeartMate 3 (HM3) left ventricular assist device (LVAD) due to accumulation of biodebris either internal or external to the graft. This study describes the prevalence, imaging findings, and clinical outcomes associated with HM3 LVAD outflow graft narrowing.A single-center retrospective cohort study was performed among patients who received a HM3 LVAD between 11/2014-7/2019. All patients with a Computed Tomography (CT) Angiography or CT with IV contrast sufficient to evaluate the outflow graft lumen were included. A narrowing was defined as a hypodensity of =3mm.Of 165 HM3 LVAD patients, 46 (28%) had qualifying imaging. Outflow graft narrowing was present in 33% (15/46). One patient had complete obstruction requiring emergency surgery, while 14 had a median (interquartile range) hypodensity of 4.5 mm (3.3-5.8). The presence of outflow graft narrowing was significantly associated with longer duration of LVAD support (588.2±277.5 vs. 131.5±170.9 days, p<0.0001). One-year survival after identification of narrowing was 93%, with death occurring in one patient with complete obstruction. Left ventricular (LV) unloading (mean percent decrease in LV end diastolic diameter at time of CT imaging vs. pre-LVAD) was 16.7% vs 17.7% in patients with and without narrowing, respectively (p=0.86).Among patients with adequate imaging, one-third have evidence of narrowing. Outflow graft narrowing due to biodebris was more likely to be found in HM3 LVAD patients with longer duration of LVAD support. There was no significant difference in LV unloading between patients with and without narrowing.

View details for DOI 10.1016/j.athoracsur.2021.12.014

View details for PubMedID 34998738