Biomaterial-Related External Outflow Graft Obstruction in HeartMate 3 Left Ventricular Assist Device: A Single-Center...

Area of Science:

• Cardiology
• Biomedical Engineering
• Surgical Complications

Background:

• HeartMate 3 (HM3) left ventricular assist devices (LVADs) have advanced cardiac support but can develop late complications.
• External outflow graft obstruction at the bend relief region (EOGO-BR) is an uncommon, severe complication with limited data on diagnosis and management.

Purpose of the Study:

• To describe the clinical presentation, diagnostic methods, surgical management, and outcomes of patients experiencing biomaterial-related EOGO-BR with HM3 LVADs.

Main Methods:

• Retrospective review of three male patients with symptomatic EOGO-BR following HM3 implantation.
• Evaluation of clinical data, diagnostic imaging (primarily computed tomography angiography - CTA), surgical interventions, and patient outcomes.

Main Results:

• All patients presented with low-flow alarms and heart failure symptoms.
• CTA successfully identified external compression of the outflow graft in all cases.
• Surgical biomaterial evacuation via left thoracotomy restored LVAD flow immediately in all patients.
• Two patients experienced favorable recovery; one patient with sepsis died.

Conclusions:

• EOGO-BR is a serious late complication of HM3 LVADs.
• CTA is a valuable tool for diagnosing EOGO-BR.
• Surgical removal of biomaterial offers immediate hemodynamic improvement and appears to be an effective treatment in selected patients.