Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

Surgical Correction of Left Ventricular Assist Device Outflow Graft Obstruction Caused by a Wrapped Expanded Polytetrafluoroethylene Graft: A Case Report

  • Sung Min Kim (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Ilkun Park (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Siwon Oh (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Hyo Won Seo (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Ga Hee Jeong (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jun Ho Lee (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Su Ryeun Chung (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kiick Sung (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Wook Sung Kim (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yang Hyun Cho (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2023.09.22
  • Accepted : 2023.12.10
  • Published : 2024.07.05
Download PDF
⟨ Previous Next ⟩

Abstract

A 70-year-old man with dilated cardiomyopathy underwent left ventricular assist device (LVAD) implantation, using a HeartWare ventricular assist device, as a bridge to candidacy. After 26 months, computed tomography (CT) angiography indicated stenosis in the LVAD outflow graft; however, the patient was asymptomatic, prompting a decision to manage his condition with close monitoring. Ten months later, the patient presented with dizziness and low-flow alerts. Subsequent CT angiography revealed a critical obstruction involving the entire LVAD outflow graft. The patient underwent emergency surgery, during which an organized seroma causing the graft obstruction was found between a wrapped expanded polytetrafluoroethylene (ePTFE) graft and a Dacron outflow graft. The covering of the outflow graft was removed, along with the organized seroma. Following removal of the ePTFE wrap and decompression of the outflow graft, normal LVAD flow was reestablished. The practice of wrapping the outflow graft with synthetic material, commonly done to facilitate later redo sternotomy, may pose a risk for outflow graft obstruction.

Keywords

Acknowledgement

This research did not receive any specific grant from funding agencies in the public, commercial, or not-forprofit sectors.

References

  1. Wert L, Stewart GC, Mehra MR, et al. A multicenter evaluation of external outflow graft obstruction with a fully magnetically levitated left ventricular assist device. J Thorac Cardiovasc Surg 2022 Oct 3 [Epub]. https://doi.org/10.1016/j.jtcvs.2022.09.051
  2. Dimitrov K, Kaider A, Angleitner P, et al. Incidence, clinical relevance and therapeutic options for outflow graft stenosis in patients with left ventricular assist devices. Eur J Cardiothorac Surg 2022;61:716-24. https://doi.org/10.1093/ejcts/ezab382
  3. Leprince P, Rahmati M, Bonnet N, et al. Expanded polytetrafluoroethylene membranes to wrap surfaces of circulatory support devices in patients undergoing bridge to heart transplantation. Eur J Cardiothorac Surg 2001;19:302-6. https://doi.org/10.1016/s1010-7940(01)00593-0
  4. Rajagopal K, Salas de Armas IA, Jumean MF, Gregoric ID. Surgical treatment of late left ventricular assist device outflow obstruction due to extrinsic compression. J Heart Lung Transplant 2019;38:472-4. https://doi.org/10.1016/j.healun.2019.02.003
  5. Jain SS, Clerkin KJ, Anstey DE, et al. Outflow graft narrowing of the HeartMate 3 left ventricular assist device. Ann Thorac Surg 2023;115:1282-8. https://doi.org/10.1016/j.athoracsur.2021.12.014
  6. Trankle CR, Grizzard JD, Shah KB, et al. Left ventricular assist device outflow graft compression: incidence, clinical associations and potential etiologies. J Card Fail 2019;25:545-52. https://doi.org/10.1016/j.cardfail.2019.05.004
  7. Trankle CR, Quader MA, Grizzard JD, et al. Internal versus external compression of a left ventricular assist device outflow graft: diagnosis with intravascular ultrasound and treatment with stenting. Circ Heart Fail 2018;11:e004959. https://doi.org/10.1161/CIRCHEARTFAILURE.118.004959
  8. Jackson GR, Brand T, Katz JN, Ikonomidis JS. Left ventricular assist device failure due to outflow graft compression by thrombofibrotic exudate. J Thorac Cardiovasc Surg 2019;157:e259-61. https://doi.org/10.1016/j.jtcvs.2018.10.069