Successful Long-Term Outflow Graft Patency Restoration With a Stent-Graft Implantation in an LVAD Recipient.

BACKGROUND

Owing to a shortage of heart donors and the increasing prevalence of end-stage heart failure, left ventricular assist device (LVAD) therapy is expanding. LVAD complications, including outflow graft (OG) obstruction, significantly affect patient prognosis.

CASE SUMMARY: We report a 70-year-old man with ischemic heart failure 2.5 years after HeartMate 3 implantation. At admission, exertion dyspnea, peripheral edema, and occasional LVAD alarms were observed, which subsequently intensified. Multimodality imaging revealed OG obstruction. OG stent-graft implantation was performed, but after patency restoration, a critical narrowing appeared, which was successfully managed with balloon angioplasty. The LVAD function and 2.5-year follow-up results were uneventful.

DISCUSSION: Percutaneous OG obstruction management in HeartMate 3 patients has been described by a few investigators, mostly with midterm follow-up.

TAKE-HOME MESSAGES: OG obstruction may require multimodality imaging and management, including multispecialty procedures. Stent-graft implantation and OG ballooning appear to be feasible treatment options for OG obstruction, with a good long-term outcomes.