Extracorporeal membrane oxygenation-assisted emergency percutaneous treatment of left ventricular assist device graft occlusion

Abstract

End-stage heart failure is more often treated with Implantable left ventricular assist device (LVAD), even if the prolonged use may increase the risk of complications. In this case, a 51-year-old male patient presented to our emergency department showing acute heart failure signs and symptoms and a dramatic reduction of LVAD flow. Laboratory tests ruled out significant haemolysis, usually associated with pump thrombosis. The echocardiogram and the computed tomography were not able to clarify the correct diagnosis. We immediately placed a veno-arterial extracorporeal membrane oxygenation, followed by a selective retrograde angiography of the pump. The images showed stenosis of the LVAD-outflow graft, suggesting a twist. Through a hand-made J-tip guidewire, we performed multiple dilatations of the occlusion using peripheral balloons. Finally, we implanted an aortic coarctation covered-stent, re-establishing an adequate cardiac output to the patient. Our case indicates that catheter-based approach in extracorporeal membrane oxygenation assistance provides an important therapeutic alternative to treat outflow graft stenosis, especially in the case of acutely unstable patient.

Keywords: Extracorporeal membrane oxygenation; Heart failure; Heart transplantation; Outflow graft obstruction; Ventricular assist device.

Fig 1

(A) Angiogram shows an occlusive stenosis of the left ventricular assist device outflow graft, (B) initial balloon dilatations with 0.035 inch guidewire hand‐made shaped tip in the proximal tract of the left ventricular assist device outflow graft, (C) aortic coarctation balloon‐expandable covered stent positioned at the tip of the guidewire near the centrifugal pump, (D) Immediate evidence of blood‐flow from the graft to the aorta, (E) a 15‐French jugular venous cannula with its flexible distal tip positioned in the pulmonary artery trunk, and (F) computed tomography‐scan volume rendering of the patent lumen of the balloon‐expandable aortic coarctation covered stent.