Ventricular Assist Device Outflow Graft Research Articles

A Clinicopathological Case of Left Ventricular Assist Device Outflow Graft Stenosis.

A Clinicopathological Case of Left Ventricular Assist Device Outflow Graft Stenosis.

Percutaneous endovascular intervention for left ventricular assist device outflow graft obstruction: A single-center experience

BackgroundOutflow graft obstruction (OGO) is an uncommon yet life-threatening complication in patients with left ventricular assist devices (LVADs). In this retrospective, single-center case series, we identify the baseline demographics and presenting features of patients who develop LVAD OGO and the procedural details and outcomes surrounding percutaneous endovascular intervention (PEI). MethodsWe conducted a retrospective review of patients with LVADs at our institution between January 2010 and February 2023 who developed OGO and were treated with PEI. Details of the PEI including procedure time, fluoroscopy time, contrast use, stent size, number of stents, change in gradient, and change in flow after intervention were collected. ResultsA total of 12 patients who had 14 cases of OGO were identified from January 2010 to February 2023. The average age at presentation was 64.78 years. Nine of the 14 cases occurred in male patients. Eleven of the 14 cases occurred with Heartware devices (2 recurrences), 2 in Heartmate 2 and 1 in Heartmate 3. Notable procedural details include a mean procedure time of 90.86 min and mean contrast use of 162.5 mL. The initial gradient across the OGO was reduced by an average of 72 %, to a mean post-PEI of 11.57 mmHg. The average number of stents to achieve this gradient was around 2.08, with the most common stent diameter being 10 mm. Thirty-day mortality after PEI was 7 % (1/14) in this high-risk patient population. ConclusionIn our single-center experience, PEI can be a safe and effective treatment for LVAD OGO.

The Impact of Left Ventricular Assist Device Outflow Graft Positioning on Aortic Hemodynamics: Improving Flow Dynamics to Mitigate Aortic Insufficiency.

Heart failure is a global health concern with significant implications for healthcare systems. Left ventricular assist devices (LVADs) provide mechanical support for patients with severe heart failure. However, the placement of the LVAD outflow graft within the aorta has substantial implications for hemodynamics and can lead to aortic insufficiency during long-term support. This study employs computational fluid dynamics (CFD) simulations to investigate the impact of different LVAD outflow graft locations on aortic hemodynamics. The introduction of valve morphology within the aorta geometry allows for a more detailed analysis of hemodynamics at the aortic root. The results demonstrate that the formation of vortex rings and subsequent vortices during the high-velocity jet flow from the graft interacted with the aortic wall. Time-averaged wall shear stress (TAWSS) and oscillatory shear index (OSI) indicate that modification of the outflow graft location changes mechanical states within the aortic wall and aortic valve. Among the studied geometric factors, both the height and inclination angle of the LVAD outflow graft are important in controlling retrograde flow to the aortic root, while the azimuthal angle primarily determines the rotational direction of blood flow in the aortic arch. Thus, precise positioning of the LVAD outflow graft emerges as a critical factor in optimizing patient outcomes by improving the hemodynamic environment.

Application of 1,000 fps High-Speed Angiography to In-Vitro Hemodynamic Evaluation of Left Ventricular Assist Device Outflow Graft Configurations.

Left ventricular assist device (LVAD)-induced hemodynamics are characterized by fast-moving flow with large variations in velocity, making quantitative assessments difficult with existing imaging methods. This study demonstrates the ability of 1,000 fps high-speed angiography (HSA) to quantify the effect of the surgical implantation angle of a LVAD outflow graft on the hemodynamics within the ascending aorta in vitro . High-speed angiography was performed on patient-derived, three-dimensional-printed optically opaque aortic models using a nonsoluble contrast media, ethiodol, as a flow tracer. Outflow graft configuration angles of 45° and 90° with respect to the central aortic axis were considered. Projected velocity distributions were calculated from the high-speed experimental sequences using two methods: a physics-based optical flow algorithm and tracking of radio-opaque particles. Particle trajectories were also used to evaluate accumulated shear stress. Results were then compared with computational fluid dynamics (CFD) simulations to confirm the results of the high-speed imaging method. Flow patterns derived from HSA coincided with the impingement regions and recirculation zones formed in the aortic root as seen in the CFD for both graft configurations. Compared with the 45° graft, the 90° configuration resulted in 81% higher two-dimensional-projected velocities (over 100 cm/s) along the contralateral wall of the aorta. Both graft configurations suggest elevated accumulated shear stresses along individual trajectories. Compared with CFD simulations, HSA successfully characterized the fast-moving flow and hemodynamics in each LVAD graft configuration in vitro , demonstrating the potential utility of this technology as a quantitative imaging modality.

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

We report on the clinical course and management of patients supported with durable implantable LVADs who developed outflow graft obstructions at a large academic center. We performed a retrospective review of patients receiving LVAD support from 2012 through 2020. Patients who developed an outflow graft obstruction diagnosed by computed tomography angiography (CTA) or angiogram were identified, and patient characteristics and outcomes were reported. Of the 324 patients supported by LVAD at our institution, 11 patients (3.4%) were diagnosed with outflow graft obstructions. The most common presentation was low flow alarms, which was present in 10/11 patients, and the remaining patient presented with lightheadedness. Patients had minimal LDH elevation with 8/11 presenting with less than 2-fold the upper limit of normal. Transthoracic echocardiograms were not diagnostic, but CTA enabled non-invasive diagnoses in 8/11 of the patients. Three patients with extrinsic compression of the outflow graft successfully underwent endovascular stent placement, and three patients with outflow cannula kinks received supportive care. Of the five patients diagnosed with intraluminal thromboses, one received a heart transplant, one underwent an outflow graft revision, and three received supportive care due to comorbidities. 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. CTA is a pivotal non-invasive diagnostic step. Patients with external compression were successfully treated with endovascular stenting.

Quantitative Assessment of Aortic Hemodynamics for Varying Left Ventricular Assist Device Outflow Graft Angles and Flow Pulsation.

Left ventricular assist devices (LVADs) comprise a primary treatment choice for advanced heart failure patients. Treatment with LVAD is commonly associated with complications like stroke and gastro-intestinal (GI) bleeding, which adversely impacts treatment outcomes, and causes fatalities. The etiology and mechanisms of these complications can be linked to the fact that LVAD outflow jet leads to an altered state of hemodynamics in the aorta as compared to baseline flow driven by aortic jet during ventricular systole. Here, we present a framework for quantitative assessment of aortic hemodynamics in LVAD flows realistic human vasculature, with a focus on quantifying the differences between flow driven by LVAD jet and the physiological aortic jet when no LVAD is present. We model hemodynamics in the aortic arch proximal to the LVAD outflow graft, as well as in the abdominal aorta away from the LVAD region. We characterize hemodynamics using quantitative descriptors of flow velocity, stasis, helicity, vorticity and mixing, and wall shear stress. These are used on a set of 27 LVAD scenarios obtained by parametrically varying LVAD outflow graft anastomosis angles, and LVAD flow pulse modulation. Computed descriptors for each of these scenarios are compared against the baseline flow, and a detailed quantitative characterization of the altered state of hemodynamics due to LVAD operation (when compared to baseline aortic flow) is compiled. These are interpreted using a conceptual model for LVAD flow that distinguishes between flow originating from the LVAD outflow jet (and its impingement on the aorta wall), and flow originating from aortic jet during aortic valve opening in normal physiological state.

Percutaneous management of left ventricular assist device outflow graft obstruction.

Percutaneous management of left ventricular assist device outflow graft obstruction.

Cerebral protection during percutaneous intervention for left ventricular assist device outflow graft obstruction.

Left ventricular assist devices (LVAD) outflow graft obstruction is an uncommon complication but carries significant morbidity and mortality. Here we provide a case series of patients with LVAD intrinsic outflow graft obstruction who are deemed to be a high surgical risk for pump exchange and, therefore, underwent percutaneous intervention with the concomitant use of neuroprotective device-Sentinel cerebral protection system(CPS)(Boston Scientific) to prevent embolic stroke. We retrospectively analyzed patients who underwent LVAD placement in our institution and developed LVAD outflow graft obstruction. The diagnosis of LVAD outflow graft obstruction was confirmed by utilizing various cardiac imaging modalities such as echocardiography and/or computed tomography angiography. All patients were treated with percutaneous intervention and a catheter-based CPS. From a total of 501 LVAD implants in our institute, 6 (1.2%) patients with LVAD outflow graft obstruction who underwent percutaneous treatment were included; 4 patients with HeartMate-IIILVAD, 1patient with HeartMate-II LVAD, and 1patient with HeartWare (HVAD). The median age of patients was 56.5 years at the time of LVAD implantation. The median time from the LVAD implantation to the episode of LVAD outflow obstruction was 1343 days. Utilization of Sentinel CPS resulted in the capture and removal of thrombus/debris in all patients. Percutaneous intervention of LVAD outflow graft obstruction is less invasive than surgical pump exchange and an acceptable alternative in properly selected patients. In our experience, utilization of a catheter-based CPScan help in reducing the incidence of periprocedural embolic events.

LVAD Outflow Graft Stenosis

Introduction Left Ventricular Assist Device (LVAD) outflow graft obstruction is a known long-term complication, etiologies for obstruction include thrombosis, kinking as well as external compression. Here we present a clinical case presenting with low LVAD flows due to external compression of the outflow graft with marked improvement after surgical intervention. Case Report A 60-year-old woman with chronic systolic heart failure secondary to non-ischemic cardiomyopathy with a HeartWare LVAD implanted 2018 presented with one month of low flows prior to admission. She was in atrial fibrillation (AF) with rapid ventricular response and volume overloaded. Despite AF rhythm control and volume optimization, flows never returned to prior baseline (Figure A). Gated cardiac CT demonstrated narrowing within the bend relief down to 3.7mm. During an echo guided ramp study aortic valve opening frequency decreased only minimally with speed up titration with slight improvement in flows. Ventriculography was significant for narrowing of the proximal outflow graft with most contrast exiting through LVOT, however, a kink in the outflow tract vs external compression could not be distinguished (Figure B). Percutaneous stenting was deemed to be too high-risk due to the proximity to the rotor blade. In the OR, fibrinous tissue between the outflow graft and the externally reinforced goretex graft covering the strain relief was identified. Via a limited left subcostal incision, the goretex graft was sharply opened from distal end to proximal end resulting in immediate LVAD flow normalization (Figures C and D). The patient discharged home on post-operative day 5. Summary Mechanical LVAD outflow graft obstructions can be catastrophic and addressing its causes requires a multidisciplinary approach. Here we present a case where a symptomatic, mechanical outflow graft obstruction was identified via multimodal imaging. The mechanical obstruction was ultimately amendable to a minimally invasive surgical approach and avoided pump exchange or even cardiac transplant. Left Ventricular Assist Device (LVAD) outflow graft obstruction is a known long-term complication, etiologies for obstruction include thrombosis, kinking as well as external compression. Here we present a clinical case presenting with low LVAD flows due to external compression of the outflow graft with marked improvement after surgical intervention. A 60-year-old woman with chronic systolic heart failure secondary to non-ischemic cardiomyopathy with a HeartWare LVAD implanted 2018 presented with one month of low flows prior to admission. She was in atrial fibrillation (AF) with rapid ventricular response and volume overloaded. Despite AF rhythm control and volume optimization, flows never returned to prior baseline (Figure A). Gated cardiac CT demonstrated narrowing within the bend relief down to 3.7mm. During an echo guided ramp study aortic valve opening frequency decreased only minimally with speed up titration with slight improvement in flows. Ventriculography was significant for narrowing of the proximal outflow graft with most contrast exiting through LVOT, however, a kink in the outflow tract vs external compression could not be distinguished (Figure B). Percutaneous stenting was deemed to be too high-risk due to the proximity to the rotor blade. In the OR, fibrinous tissue between the outflow graft and the externally reinforced goretex graft covering the strain relief was identified. Via a limited left subcostal incision, the goretex graft was sharply opened from distal end to proximal end resulting in immediate LVAD flow normalization (Figures C and D). The patient discharged home on post-operative day 5. Mechanical LVAD outflow graft obstructions can be catastrophic and addressing its causes requires a multidisciplinary approach. Here we present a case where a symptomatic, mechanical outflow graft obstruction was identified via multimodal imaging. The mechanical obstruction was ultimately amendable to a minimally invasive surgical approach and avoided pump exchange or even cardiac transplant.

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

<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.

Left Ventricular Assist Device Outflow Graft Obstruction Caused by Extrinsic Compression

<h3>Introduction</h3> Left ventricular assist device (LVAD) outflow graft obstruction is a rare, but serious complication. A polytetrafluoroethylene (PTFE) graft covering has been used by some surgeons to reduce the frequency of adhesions and risk upon re-entry to the chest. Extra-luminal accumulation of material into the space between the graft and PTFE covering is one extremely rare cause of external compression and outflow graft obstruction. <h3>Case Report</h3> A 49-year-old male with a history of heart failure status post HeartWare LVAD with pump exchange one year previous due to thrombosis presented with a low flow alarm. His normal LVAD parameters were Flow 5.8 LPM, speed 3000 RPM, and power 6 Watts (W). On interrogation, he had a drop in flow to 2 LPM and power to 4 W beginning two days prior to presentation. Lab work was inconsistent with acute anemia, thrombosis, or hemolysis. Computed tomography angiography of the chest demonstrated outflow graft narrowing. He was taken to the OR for exploration which revealed accumulation of thick, proteinaceous material had accumulated between the outflow graft and the PTFE covering causing external compression and flow limiting stenosis. After removal of the external covering and relief of the obstruction, his flows increased from 2 to 6 LPM and power from to 4 to 6 W. <h3>Summary</h3> Evaluation of LVAD alarms can be difficult. Upon review of labs and imaging, an extraluminal compression of the outflow graft was suspected. LVAD outflow obstruction is a rare, but serious complication. One cause is accumulation of proteinaceous material between the semipermeable graft and the impermeable PTFE covering thought to be derived plasma contents. There is no consensus on treatment. Case series suggest percutaneous stenting or pump exchange. Surgical intervention can provide immediate relief of this problem.

Three-Dimensional Computed Tomography Reconstruction for Diagnosis of Left Ventricular Assist Device Outflow Graft Twist.

HomeCirculation: Cardiovascular ImagingVol. 15, No. 4Three-Dimensional Computed Tomography Reconstruction for Diagnosis of Left Ventricular Assist Device Outflow Graft Twist No AccessCase ReportRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplementary MaterialsNo AccessCase ReportRequest AccessFull TextThree-Dimensional Computed Tomography Reconstruction for Diagnosis of Left Ventricular Assist Device Outflow Graft Twist Boaz Elad, MD, Jonathan Lessick, MD, DSc, Zvi Adler, MD and Oren Caspi, MD, PhD Boaz EladBoaz Elad Department of Cardiology (B.E., J.L., O.C.), Rambam Health Care Campus and the Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel. Search for more papers by this author , Jonathan LessickJonathan Lessick Department of Cardiology (B.E., J.L., O.C.), Rambam Health Care Campus and the Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel. Search for more papers by this author , Zvi AdlerZvi Adler Cardiovascular Surgery (Z.A.), Rambam Health Care Campus and the Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel. Search for more papers by this author and Oren CaspiOren Caspi Correspondence to: Oren Caspi, MD, PhD, Department of Cardiology, Rambam Health Care Campus and, the B. Rappaport Faculty of Medicine, Technion, Haifa, Israel, POB 9602, Haifa 31096, Israel. Email E-mail Address: [email protected] https://orcid.org/0000-0002-2464-7357 Department of Cardiology (B.E., J.L., O.C.), Rambam Health Care Campus and the Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel. Search for more papers by this author Originally published29 Mar 2022https://doi.org/10.1161/CIRCIMAGING.121.013714Circulation: Cardiovascular Imaging. 2022;15FootnotesSupplemental Material is available at https://www.ahajournals.org/doi/suppl/10.1161/CIRCIMAGING.121.013714.For Sources of Funding and Disclosures, see page 282.Correspondence to: Oren Caspi, MD, PhD, Department of Cardiology, Rambam Health Care Campus and, the B. Rappaport Faculty of Medicine, Technion, Haifa, Israel, POB 9602, Haifa 31096, Israel. Email [email protected]gov.il

Intravascular ultrasound with blood flow visualization to detect pseudo intimal graft dissection as a cause of left ventricular assist device outflow graft stenosis.

Intravascular ultrasound with blood flow visualization to detect pseudo intimal graft dissection as a cause of left ventricular assist device outflow graft stenosis.

Outflow graft obstruction after left ventricular assist device implantation: a retrospective, single-centre case series.

AimsOutflow graft obstruction is a poorly described complication following left ventricular assist device (LVAD) surgery. We sought to define the incidence of LVAD outflow graft obstruction and assess clinical outcomes with a percutaneous treatment strategy.Methods and resultsFrom January 2012 to October 2020, 322 patients with LVAD were managed at our institution. Patients with LVAD outflow graft obstruction were identified by cardiac computed tomography with angiography and invasive haemodynamic assessment and were subsequently treated with percutaneous intervention. Poisson regression was used to analyse time‐dependent differences in the incidence of LVAD outflow graft obstruction. Kaplan–Meier analysis was used to estimate survival. Twenty patients (6.2%) developed haemodynamically significant LVAD outflow graft obstruction at a rate of 0.03 events per patient‐year. Outflow graft obstruction presented a median of 33 (26–49) months after surgery. Patients presented with low estimated LVAD pump flow (95%), heart failure (90%), or both (85%), and 59% developed cardiogenic shock prior to intervention. The most common aetiology identified by cardiac computed tomography with angiography was external compression of the outflow graft (78%). On presentation, the median peak gradient in the outflow graft was 78 (64–100) mmHg. Outflow graft stenting was 100% successful with no in‐hospital mortality, and it reduced the peak outflow graft gradient to 10 (2–17) mmHg (P < 0.001). Outflow graft stenting was durable with two patients (10%) requiring a repeat procedure over a median follow‐up of 13 (7–20) months and did not impact survival.ConclusionsLeft ventricular assist device outflow graft obstruction is a relatively common and underappreciated cause of recurrent heart failure and LVAD dysfunction. Outflow graft stenting can be achieved with low morbidity and provides a long‐term solution to this complication.

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.

An interventional approach to left ventricular assist device outflow graft obstruction.

LVADs provide life-sustaining treatment for patients with heart failure, but their complexity allows for complications. One complication, LVAD outflow graft obstruction, may be misdiagnosed as intraluminal thrombus, when more often it is extraluminal compression from biodebris accumulation. It can often be treated endovascularly with stenting. This case series describes diagnostic and procedural techniques for the treatment of left ventricular assist device (LVAD) outflow graft obstruction. We present four patients with LVADs who developed LVAD outflow graft obstruction within the bend relief-covered segment. All were initially diagnosed with computed tomographic angiography (CTA). All underwent invasive evaluation with intravascular ultrasound (IVUS), then were treated with stenting. After misdiagnosing a twist, we developed the technique of balloon "graftoplasty" to ensure suitability for stent delivery in subsequent cases. All patients presented with low-flow alarms and symptoms of low output, and were diagnosed with outflow graft obstruction by CTA. In all four, IVUS confirmed an extraluminal etiology. Patient 1 was treated with stenting and had a good outcome. Patient 2's obstruction was from twisting, rather than biodebris accumulation, and had sub-optimal stent expansion and ultimately required surgery. Balloon "graftoplasty" was used in subsequent cases to ensure subsequent stent expansion. Patients 3 and 4 were successfully stented. All improved after treatment. In patients with LVAD outflow graft obstruction, IVUS can distinguish intraluminal thrombus from extraluminal compression. Balloon "graftoplasty" can ensure that the outflow graft will respond to stenting. Many cases of LVAD outflow graft obstruction should be amenable to endovascular treatment.

Transcervical approach for left ventricular assist device outflow graft: A proof-of-concept implantation study.

Minimally invasive techniques to implant centrifugal left ventricular assist devices (LVADs) have been described as alternatives to the classic full sternotomy approach. Implantation of the pump is done through a left anterior thoracotomy. The outflow graft is anastomosed to the ascending aorta via upper hemisternotomy or right anterior thoracotomy.1,2

A New Strategy for Left Ventricular Assist Device Outflow Graft Interrogation Using Ultrasound Contrast

Interrogation of the outflow graft (OTG)-ascending aorta anastomosis is an integral part of the transthoracic echocardiographic (TTE) evaluation of left ventricular assist devices (LVADs) as it is important to confirm patency of this communication. However, it can be challenging to image the OTG anastomosis on TTE. Ultrasound enhancing agents (UEAs) have been used successfully to enhance visualization of endocardial borders and intracardiac masses.1-3 We hypothesized that UEAs would improve OTG detection, optimize the alignment of Doppler velocity signals with graft flow, and enable more meaningful peak velocity measurements across the anastomosis of the OTG to the ascending aorta.

Treatment of outflow graft stenosis in left ventricular assist device patients: Endovascular approach

Left ventricular assist device outflow graft stenosis is a rare, but a lethal complication. Device replacement or thrombolytic treatments are associated with serious mortality and morbidity. Implantation of covered stents is a less invasive option. Herein, we represent a successful stent placement of two cases with outflow graft stenosis, which we performed by leaving the stents on the aortic side of the anastomosis line 5 to 10 mm. This treatment option can be used reliably in cases of stenosis of the outflow graft with part of the stent leaving the aorta.

Endovascular repair of left ventricular assist device outflow graft defect

Outflow graft complications after left ventricular assist device placement are infrequent but highly morbid. In this case report, we describe endovascular repair of multiple outflow graft defects with external hemorrhage in a complex patient using overlapping stent grafts. This approach successfully stopped the outflow graft hemorrhage and temporized the patient for subsequent cardiac transplantation.