Emergent decommissioning of HeartMate 3 for life-threatening hemorrhage

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Medical Device Technology

Background:

• Left ventricular assist devices (LVADs) are critical for end-stage heart failure treatment.
• Complications such as hemorrhage can necessitate emergent device management.
• Outflow graft avulsion from the subclavian artery is a rare but severe LVAD complication.

Observation:

• A patient presented with life-threatening hemorrhage due to left ventricular assist device outflow graft avulsion from the left subclavian artery.
• The emergent procedure involved using a covered stent to exclude the avulsed graft and an Amplatzer II plug to occlude the inflow cannula.
• Accessing the inflow cannula presented significant technical challenges during the procedure.

Findings:

• Successful management of life-threatening hemorrhage secondary to LVAD outflow graft avulsion was achieved using a combination of a covered stent and an occlusion device.
• The technical difficulties encountered underscore the complexity of managing emergent LVAD-related vascular complications.
• Retrospective analysis suggests that preemptive occlusion of the outflow graft via the subclavian artery prior to stent deployment could offer a simplified approach.

Implications:

• This case demonstrates a viable strategy for managing severe LVAD outflow graft avulsion, offering a potential alternative to explantation.
• The findings highlight the importance of considering anatomical access and potential complications when planning LVAD interventions.
• Improved techniques for managing emergent LVAD complications could enhance patient outcomes and reduce procedural risks.