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Cerebral protection during percutaneous intervention for left ventricular assist device outflow graft obstruction
Abdulaziz Joury1,2, Rajan A G Patel1,3,4, James Wever-Pinzon1,5
1John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, Louisiana, USA.
Insights
Left ventricular assist device (LVAD) outflow graft obstruction can be treated with minimally invasive percutaneous intervention. Using a cerebral protection system (CPS) during this procedure helps prevent embolic stroke complications in high-risk patients.
Area of Science:
- Cardiology
- Medical Devices
- Interventional Procedures
Background:
- Left ventricular assist device (LVAD) outflow graft obstruction is a rare but serious complication.
- High surgical risk patients with LVAD obstruction may benefit from alternative treatments.
Purpose of the Study:
- To evaluate the efficacy and safety of percutaneous intervention for LVAD outflow graft obstruction.
- To assess the role of the Sentinel cerebral protection system (CPS) in preventing embolic events during this intervention.
Main Methods:
- Retrospective analysis of patients who underwent LVAD implantation and developed outflow graft obstruction.
- Diagnosis confirmed via echocardiography and/or computed tomography angiography.
- Treatment involved percutaneous intervention with concomitant use of a catheter-based CPS.
Main Results:
- Six patients (1.2%) with LVAD outflow graft obstruction were treated percutaneously.
- Patients had various LVAD types including HeartMate-III, HeartMate-II, and HeartWare (HVAD).
- Sentinel CPS successfully captured thrombus/debris in all treated patients.
Conclusions:
- Percutaneous intervention is a less invasive and acceptable alternative to surgical pump exchange for LVAD outflow graft obstruction in select patients.
- Catheter-based cerebral protection systems (CPS) can reduce the incidence of periprocedural embolic events.
Background:
Left ventricular assist devices (LVAD) outflow graft obstruction is an uncommon complication but carries significant morbidity and mortality. Here we provide a case series of patients with LVAD intrinsic outflow graft obstruction who are deemed to be a high surgical risk for pump exchange and, therefore, underwent percutaneous intervention with the concomitant use of neuroprotective device-Sentinel cerebral protection system (CPS) (Boston Scientific) to prevent embolic stroke.
Methods:
We retrospectively analyzed patients who underwent LVAD placement in our institution and developed LVAD outflow graft obstruction. The diagnosis of LVAD outflow graft obstruction was confirmed by utilizing various cardiac imaging modalities such as echocardiography and/or computed tomography angiography. All patients were treated with percutaneous intervention and a catheter-based CPS.
Results:
From a total of 501 LVAD implants in our institute, 6 (1.2%) patients with LVAD outflow graft obstruction who underwent percutaneous treatment were included; 4 patients with HeartMate-III LVAD, 1 patient with HeartMate-II LVAD, and 1 patient with HeartWare (HVAD). The median age of patients was 56.5 years at the time of LVAD implantation. The median time from the LVAD implantation to the episode of LVAD outflow obstruction was 1343 days. Utilization of Sentinel CPS resulted in the capture and removal of thrombus/debris in all patients.
Conclusions:
Percutaneous intervention of LVAD outflow graft obstruction is less invasive than surgical pump exchange and an acceptable alternative in properly selected patients. In our experience, utilization of a catheter-based CPS can help in reducing the incidence of periprocedural embolic events.
