Outflow Graft Obstruction Causing Recurrent Heart Failure after Left Ventricular Assist Device Implantation

Purpose Outflow graft obstruction is a poorly described complication following continuous flow-left ventricular assist device (CF-LVAD) surgery. We sought to define the incidence of CF-LVAD outflow graft obstruction and assess clinical outcomes with a percutaneous treatment strategy. Methods From January 2012 to June 2019, 252 CF-LVAD patients were managed at our institution. Patients with suspected LVAD outflow graft obstruction underwent comprehensive evaluation with Doppler echocardiography, cardiac computed tomography with angiography and invasive hemodynamic assessment followed by percutaneous intervention. Results Fourteen patients (5.6%) developed hemodynamically significant LVAD outflow graft obstruction at a rate of 0.03 events per patient-year. Outflow graft obstruction presented a mean of 34±18 months after surgery. Patients presented with heart failure (HF; 86%), low LVAD pump flow (93%), or both (79%). LVAD flow declined by an average of 2.1±0.8L/min (p Conclusion LVAD outflow graft obstruction is a relatively common and underappreciated cause of recurrent HF and LVAD dysfunction. Outflow graft stenting can be achieved with low morbidity and provides a long-term solution to this complication.