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Case Reports
. 2022 May 14;19(10):5976.
doi: 10.3390/ijerph19105976.

A Redo Percutaneous Emergency Intervention of Left Ventricular Assist Device Graft Occlusion

Rocco Edoardo Stio  1 , Marina Comisso  2 , Luca Paolucci  1 , Silvio Coletta  1 , Vincenzo Cesario  1 , Michele Gioia  1 , Marco Stefano Nazzaro  1 , Guglielmo Saitto  2 , Carlo Contento  3 , Emilio D'Avino  3 , Francesco De Felice  1 , Domenico Gabrielli  1 , Francesco Musumeci  2
Affiliations
Case Reports

A Redo Percutaneous Emergency Intervention of Left Ventricular Assist Device Graft Occlusion

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

Abstract

In patients with advanced heart failure (HF), left ventricular assist devices (LVADs) have demonstrated to be effective in improving the quality of life and reducing further hospitalizations. Although uncommon, LVAD outflow graft obstruction (OGO) is a potentially life-threatening complication and percutaneous treatment has been proposed as a standard intervention strategy in such cases. We report the case of a 69 year old man admitted due to LVAD failure causing unstable HF. Past medical history included percutaneous intervention on the outflow graft with stent implantation one year before. The patient was under chronic treatment with vitamin K antagonists (VKA). Emergent percutaneous angiography was performed, showing recurrent OGO due to thrombosis located at a kinking site, distally to the previously treated segment. Using distal anchoring technique, a balloon-expandable 10 × 79 mm endoprosthesis (GORE® Viabahn® VBX) was effectively positioned and post-dilated. Final angiography confirmed the patency of the stent implanted one-year before. Despite the procedure succeeding in restoring LVAD function, the patient died due to septic shock ten days after. Our case suggests that recurrent OGO can be effectively treated with percutaneous redo and that long-term stent patency can be achieved with a standard antithrombotic treatment, despite further thrombotic events in other segments of the graft are still possible (especially at the kinking site). Moreover, other noncardiac conditions as infective complications, can dramatically impact the clinical course and lead to unfavorable outcomes.

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) preprocedural angiography of the first outflow graft obstruction episode (yellow arrows highlighting the kinking site and proximal thrombosis location); (B) result following the first percutaneous intervention.
Figure 2
Figure 2
Diagnostic angiography showing recurrent outflow graft obstruction (yellow arrow).
Figure 3
Figure 3
(A) distal anchoring; (B) stent deployment.
Figure 4
Figure 4
Postdilation of the implanted stent.
Figure 5
Figure 5
Final result following the percutaneous intervention.
See this image and copyright information in PMC

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