Durable Left Ventricular Assist Device Outflow Graft Obstructions: Clinical Characteristics And Outcomes

Purpose Despite significant improvements in survival with continuous flow left ventricular assist devices (LVADs), outflow graft obstruction remains a rare, but serious complication. We report the clinical course and management of patients supported with LVADs who were diagnosed with outflow graft obstruction at a large academic center. Methods We performed a retrospective review of patients receiving LVAD support from January 2012 through September 2020. Patients who developed outflow graft obstruction diagnosed by computed tomography angiography (CTA) or angiogram were identified, and patient characteristics and outcomes were reported. Results Of 324 patients supported by LVAD at our institution between January 2012 and February 2020, 10 patients (3.2%) were diagnosed with outflow graft obstruction. The most common presentation was low flow alarms, which was present in 8/10 patients. The other two patients had lightheadedness and/or dyspnea. Patients had minimal LDH elevation with 7/10 presenting with less than 2-fold the upper limit of normal. Transthoracic echocardiograms were not diagnostic, but CTA enabled non-invasive diagnoses in 8/10 of the patients. Three patients were treated with endovascular stent placement, while one received heart transplant, one had an increase in INR goal, and one had an LVAD outflow revision; all of whom are still living. Three patients were treated with supportive care with two expiring away shortly after. The last patient was treated with tPA and also expired. Conclusion Outflow graft obstructions remain a rare, but serious complication. The true prevalence of this entity is likely underestimated due to the non-specific clinical presentation and the fact that CTA is not a part of routine standard of care.