Left Ventricular Assist Device Outflow Graft Compression: Incidence, Clinical Associations and Potential Etiologies
| Autor: | Keyur B. Shah, John D. Grizzard, Cory R. Trankle, Zachary M. Gertz, Andrew E. Andreae, Matthew S. Kang, Leila Rezai Gharai, Franklin Dana, Mohammed A. Quader, K. Desai |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
Reoperation medicine.medical_specialty Computed Tomography Angiography medicine.medical_treatment Lumen (anatomy) 030204 cardiovascular system & hematology Prosthesis Design Prosthesis Implantation 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Clinical significance 030212 general & internal medicine Computed tomography angiography Heart Failure medicine.diagnostic_test business.industry Incidence Graft Occlusion Vascular Middle Aged medicine.disease Compression (physics) United States Equipment Failure Analysis Outcome and Process Assessment Health Care Ventricular assist device Heart failure Cardiology Outflow Female Stents Implant Heart-Assist Devices Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of cardiac failure. 25(7) |
| ISSN: | 1532-8414 |
| Popis: | Background Left ventricular assist devices (LVADs) have revolutionized the treatment of advanced heart failure, but proliferation of device therapy has unmasked potential complications. Reports have emerged of outflow graft narrowing due to extrinsic compression. Methods and Results The records of patients with LVADs that had been implanted at our institution were reviewed. Those who had postimplantation computed tomography angiographies sufficient to analyze the outflow graft lumen were identified, and the studies were analyzed to characterize the outflow graft lumen. We identified 241 patients; 110 (46%) had suitable computed tomography angiographies. Of those, 15 (14%) had evidence of outflow graft lumen narrowing, all in HeartMate devices and all within the portion covered by the bend relief. Of the 15, 3 underwent invasive examination, all without intraluminal thrombus but, rather, with biodebris between the bend relief and the outflow graft. Patients with HeartWare devices had a wide range of biodebris accumulation surrounding the outflow graft but no cases of lumen narrowing. On multivariable analysis, 1) time from device implant to scan, 2) nonischemic cardiomyopathy and 3) age at implant were significantly associated with higher risk of graft narrowing. Conclusion Outflow graft narrowing can be seen in a number of patients with HeartMate LVADs within the portion covered by the bend relief. In the limited number of patients who underwent invasive evaluation, the narrowing was found to arise from extrinsic compression rather than intraluminal thrombus. The clinical significance of this requires further investigation. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect