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Acute Left Ventricular Assist Device Failure From Outflow Graft Dissection Flap Successfully Treated With Stent
Gabriel A Hernandez1, Khawaja M Talha, Brandon Lennep
1From the Division of Cardiology, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi.
ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|November 21, 2022
Summary
Outflow graft obstruction (OGO) is a serious complication of left ventricular assist devices (LVADs). A rare neointimal flap dissection, not thrombosis, was identified as the cause in one patient, requiring stenting for resolution.
Area of Science:
- Cardiovascular Surgery
- Medical Devices
- Interventional Cardiology
Background:
- Outflow graft obstruction (OGO) is a critical complication following left ventricular assist device (LVAD) implantation.
- Common causes include graft kinking, stenosis, and thrombosis, often leading to acute device failure.
Observation:
- A 51-year-old female patient experienced acute LVAD failure and cardiogenic shock.
- Initial imaging showed OGO without stenosis, and empirical treatment for thrombosis (anticoagulation, thrombolysis) was ineffective.
Findings:
- Advanced imaging revealed a neointimal flap dissection acting as a one-way valve causing the OGO.
- Successful stent placement across the outflow graft resolved the obstruction and cardiogenic shock.
Implications:
- This case highlights the importance of considering neointimal flap dissection in the differential diagnosis of OGO.
- It underscores the need for advanced imaging and intervention when standard treatments for graft thrombosis fail in LVAD patients.
