The Effect of Multiple Outflow Graft Stenting on Hemodynamics in the Treatment of Left Ventricular Assist Device Outflow Graft Stenosis

Abstract

<h3>Introduction</h3> Outflow graft stenosis is a potential complication of durable left ventricular assist device implantation. It presents with reduced LVAD flow, increased power requirement and decompensated left heart failure. Percutaneous intervention for OFG stenosis with single OFG stenting has been described. We present a case of decompensated heart failure due to LVAD OFG stenosis successfully managed with multiple OFG stenting. <h3>Case Report</h3> A 31 year old male with nonischemic cardiomyopathy underwent LVAD implantation 6 years ago with 20cm PTFE graft covering the OFG. He presented with acute decompensated left heart failure due to decreased LVAD flow on prior settings. Contrast CT showed OFG stenosis. Cardiac catheterization demonstrated 130mmHg pressure gradient. OFG angiography revealed 80% stenosis inside the PTFE graft. Four overlapping OFG stents were placed reducing gradient to 10mmHg. There was significant hemodynamic improvement with return of LVAD flow to baseline. <h3>Summary</h3> LVAD OFG stenosis may be caused by exudate overlying OFG covered by PTFE graft or the original bend relief. Successful surgical and percutaneous intervention for this complication has been reported. We observed the hemodynamic impact of multiple OFG stenting on OFG stenosis with return of LVAD flow to baseline. Multiple stents may be needed for long OFG covering since the exudate outside the OFG may worsen stenosis next to the stent. Our case of LVAD dysfunction due to OFG stenosis successfully managed with multiple OFG stenting affirms the essential role of this percutaneous intervention in managing this complication.