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Use of Two Intracorporeal Ventricular Assist Devices As a Total Artificial Heart
Published on: May 11, 2018
Survival outcomes of stenting outflow graft stenosis in continuous-flow left ventricular assist devices: a systematic
Chelsey T Wood1, Thomas J O'Malley1, Elizabeth J Maynes1
1Division of Cardiac Surgery, Thomas Jefferson University, 1025 Walnut St, Suite 607, Philadelphia, PA, 19107, USA.
Insights
Stenting continuous-flow left ventricular assist device (CF-LVAD) outflow grafts effectively resolves obstructions, improving device flow. This intervention shows promising results with low mortality rates in patients with advanced heart failure.
Area of Science:
- Cardiology
- Biomedical Engineering
- Interventional Cardiology
Background:
- Continuous-flow left ventricular assist devices (CF-LVADs) are crucial for end-stage heart failure.
- Outflow graft complications, including stenosis and thrombosis, can impair CF-LVAD function.
- Percutaneous intervention offers a potential solution for these graft issues.
Purpose of the Study:
- To discuss indications for percutaneous intervention in CF-LVAD outflow graft complications.
- To evaluate the efficacy of outflow graft stenting in restoring adequate CF-LVAD flow.
- To assess the safety and outcomes of this interventional approach.
Main Methods:
- An electronic literature search identified 21 studies with 26 patients undergoing CF-LVAD outflow graft stenting.
- Patient-level data, including device type, complication, and outcomes, were extracted and analyzed.
- Statistical analysis was performed on pre- and post-intervention flow rates, discharge status, and mortality.
Main Results:
- The most common complications were thrombosis and stenosis (34.6% each).
- Immediate flow improvement was observed in 88.5% of patients post-stenting (2.9 to 4.7 L/min).
- Discharge was achieved in 96.2% of patients, with low 30-day (6.7%) and 90-day (9.5%) mortality.
Conclusions:
- Outflow graft stenting is an effective treatment for CF-LVAD outflow graft obstruction.
- The procedure is associated with significant flow improvement and favorable patient outcomes.
- Percutaneous stenting represents a safe and viable option for managing CF-LVAD outflow graft complications.
Abstract:
Stenosis in the continuous-flow left ventricular assist device (CF-LVAD) outflow graft is caused by various factors. We discuss indications for percutaneous intervention of outflow graft complications and evaluate the use of this treatment in re-establishing adequate CF-LVAD flow. An electronic search was performed to identify all studies in the English literature reporting CF-LVAD outflow graft stenting. Twenty-one studies consisting of 26 patients were included. Patient-level data were extracted for statistical analysis. Median patient age was 59 years [45.8-67.0] and 65.4% (17/26) were male. 58.3% (14/24) of patients had HeartWare HVAD, 37.5% (9/24) had HeartMate II LVAD, and 4.2% (1/24) had HeartMate III LVAS. Median time from device placement to outflow graft stenting was 24.0 months [7.8-30.4]. 76.9% of patients (20/26) presented with heart failure. Complications of the CF-LVAD outflow graft included thrombosis in nine patients (34.6%), stenosis in nine patients (34.6%), kinking in three patients (11.5%), pseudoaneurysm in one patient (3.8%), external graft compression in one patient (3.8%), and bronchial-arterial fistula in one patient (3.6%). Immediate flow improvement occurred in 23/26 patients (88.5%), with the remaining 11.5% (3/26) requiring additional procedures. Pre- and post-intervention flows were 2.9 L/min [2.0-3.5] and 4.7 L/min [4.1-4.8] respectively (p = 0.01). Of patients, 96.2% (25/26) were discharged with a median time to discharge of 4 days [3.0-5.0]. The 30-day mortality was 6.7% (1/15). Overall mortality during the median follow-up of 90 days was 9.5% (2/21). Outflow graft stenting appears to effectively alleviate CF-LVAD outflow graft obstruction and is associated with low overall mortality.
