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Case Reports
. 2022 Feb 20;19(4):2441.
doi: 10.3390/ijerph19042441.

A Case of Successful Use of the "Anchoring Technique" for Percutaneous Treatment of Left Ventricular Assist Device Graft Occlusion

Rocco Edoardo Stio  1 , Andrea Montalto  2 , Alfredo Intorcia  1 , Vincenzo Polizzi  2 , Mariano Feccia  2 , Carmine Musto  1 , Mauro Pennacchi  1 , Luca Paolucci  1 , Regina Stumpo  3 , Emilio D'Avino  4 , Francesco De Felice  1 , Domenico Gabrielli  1 , Francesco Musumeci  2
Affiliations
Case Reports

A Case of Successful Use of the "Anchoring Technique" for Percutaneous Treatment of Left Ventricular Assist Device Graft Occlusion

Rocco Edoardo Stio et al. Int J Environ Res Public Health. .

Abstract

Left ventricular assist device (LVAD) obstruction can be a dramatic and life-threatening complication in patients with advanced heart failure (HF). Despite surgical redo is often required in these patients, it is associated with a high risk of periprocedural negative outcome. We report the case of a 68-year-old male with a thrombotic stenosis of the LVAD proximal outflow-graft. Following Heart Team debate, a percutaneous intervention was planned during veno-arterial Extra Corporeal Membrane Oxygenation (ECMO) assistance. To achieve the needed catheter support, we used the "distal balloon anchoring technique" through the outflow-graft and managed to implant a covered stent, rapidly restoring the flow through the LVAD. The patient was discharged without further complications. Our case shows that, in selected cases, percutaneous treatment of LVAD obstructions can be feasible, especially using advanced techniques derived from the experiences in coronary interventions and under ECMO assistance. More cases and prospective studies are mostly needed to explore long-term patency of the LVADs and clinical outcomes in these high-risk patients.

Keywords: heart failure; left ventricular assist device; percutaneous coronary intervention.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(A) chest CT-scan coronal-view focused on of LVAD outflow-graft; (B) CT-scan sagittal-view showed an image suggesting a thrombus in the proximal part of the LVAD outflow-graft.
Figure 2
Figure 2
The retrograde angiography of the LVAD outflow-graft showed a kinking in the distal tract, followed by a thrombotic stenosis near the ostium of the pump (marked respectively by yellow arrows on the left and below the outflow graft).
Figure 3
Figure 3
(A) the “distal balloon anchoring technique” was used to improve support for deliverability of balloon and stents. (B) balloon inflated at distal portion of the target lesion enabled us to advance the 8 Fr long sheath till the proximal part of the graft (C). a balloon-expandable covered-stent 10 × 59 mm was successfully implanted. (D) the delivery of the stent resulted in immediate evidence of blood-flow improvement through the outflow graft.
See this image and copyright information in PMC

References

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