Endovascular Stent Grafting of a Left Ventricular Assist Device Outflow Graft Pseudoaneurysm

Abstract

A 61-year-old female underwent implantation of a Heartmate II left ventricular assist device (LVAD; Thoratec Corporation, Pleasanton, CA) for end-stage nonischemic cardiomyopathy. Six months later, she presented with chest pain and worsening heart failure symptoms. Computed tomography angiography revealed a large subxiphoid pseudoaneurysm with peripheral thrombus exerting a mass effect on the heart (Figures 1 and 2). Further evaluation by ultrasonography with anterior chest transducer placement confirmed a 13-cm pseudoaneurysm with multiple connections to the LVAD outflow Dacron graft (Figure 3). She was afebrile and had no physical or laboratory evidence of infection. Because of extensive comorbidities, including morbid obesity, restrictive lung disease, and chronic renal insufficiency, open repair via repeat sternotomy was considered risk-prohibitive, and an endovascular repair was pursued. Figure 1. Axial computed tomography angiography image demonstrating the large subxiphoid pseudoaneurysm ( red arrow ) with area of communication to the outflow graft of the left ventricular assist device (LVAD; yellow arrow ). Figure 2. Three-dimensional computed tomography angiography reconstruction demonstrating pseudoaneurysm ( yellow arrow ) arising from the outflow graft ( blue arrow ) of the left ventricular assist device (LVAD; red arrow ). Figure 3. A , Sagittal ultrasonographic view of the anterior chest demonstrating a 13×9 cm fluid collection (demarcated by + symbols) surrounding the outflow tract ( red arrow ) from the left ventricular apex ( yellow arrow ) to the left ventricular assist device (LVAD). B , Sagittal Doppler view demonstrating swirling flow within the fluid collection consistent with pseudoaneurysm. Off-label use of a Gore …