Late inflow or outflow obstruction requiring surgical intervention after HeartMate 3 left ventricular assist device

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Yuji Kaku1, Yoshifumi Naka1, Lucas Witer1

  • 1Division of Cardiac Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA.

Interactive Cardiovascular and Thoracic Surgery
|September 5, 2020
PubMed

Insights

Late obstruction of HeartMate 3 left ventricular assist devices is rare but critical. Prompt surgical correction of inflow or outflow obstruction after HeartMate 3 implantation leads to favorable outcomes.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Medical Devices

Background:

  • HeartMate 3 left ventricular assist device (LVAD) implantation is a critical procedure for advanced heart failure.
  • Inflow or outflow obstruction represents a rare but serious complication following LVAD implantation.

Purpose of the Study:

  • To investigate the incidence, presentation, and outcomes of inflow or outflow obstruction in HeartMate 3 LVAD recipients.
  • To evaluate the effectiveness of surgical intervention for these obstructions.

Main Methods:

  • Retrospective review of 166 patients undergoing primary HeartMate 3 implantation from November 2014 to July 2019.
  • Identification of cases with inflow or outflow obstruction.
  • Analysis of clinical presentation, diagnostic methods (including computed tomography angiogram), surgical correction, and patient outcomes.

Main Results:

  • Six cases (3 inflow, 3 outflow obstruction) were identified.
  • Low flow alarm was the most common presenting sign; most patients were asymptomatic of heart failure.
  • Median time to reintervention was 406.5 days; computed tomography angiogram identified the issue in 5/6 cases.
  • Surgical correction resolved symptoms in most cases, with all patients alive at a median follow-up of 433.5 days.

Conclusions:

  • Late inflow or outflow obstruction is a critical complication of HeartMate 3 LVAD.
  • Prompt surgical intervention for HeartMate 3 obstruction is associated with favorable outcomes.
  • Continued monitoring and timely intervention are crucial for managing LVAD complications.

Keywords:
Heart failureLeft ventricular assist device

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