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A multicenter evaluation of external outflow graft obstruction with a fully magnetically levitated left ventricular assist device
L. Wert, GC. Stewart, MR. Mehra, A. Milwidsky, UP. Jorde, DJ. Goldstein, CH. Selzman, J. Stehlik, FD. Alshamdin, FH. Khaliel, F. Gustafsson, S. Boschi, A. Loforte, S. Ajello, AM. Scandroglio, Z. Tučanová, I. Netuka, T. Schlöglhofer, D. Zimpfer,...
Jazyk angličtina Země Spojené státy americké
Typ dokumentu multicentrická studie, časopisecké články
- MeSH
- lidé MeSH
- počítačová rentgenová tomografie MeSH
- podpůrné srdeční systémy * škodlivé účinky MeSH
- retrospektivní studie MeSH
- srdeční selhání * MeSH
- transplantace srdce * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
BACKGROUND: The HeartMate 3 (HM 3; Abbott) left ventricular assist device (LVAD) has improved hemocompatibility-related adverse outcomes. In sporadic cases, external compression of the outflow graft causing obstruction (eOGO) can result from substance accumulation between the outflow graft and its bend relief. We sought to evaluate the prevalence, course, and clinical implications of eOGO in an international study. METHODS: A multicenter retrospective analysis of HM 3 LVADs implanted between November 2014 and April 2021 (n = 2108) was conducted across 17 cardiac centers in 8 countries. We defined eOGO as obstruction >25% in the cross-sectional area in imaging (percutaneous angiography, computed tomography, or intravascular ultrasound). The prevalence and annual incidence were calculated. Serious adverse events and outcomes (death, transplantation, or device exchange) were analyzed for eOGO cases. RESULTS: Of 2108 patients, 62 were diagnosed with eOGO at a median LVAD support duration of 953 (interquartile range, 600-1267) days. The prevalence of eOGO was 3.0% and the incidence at 1, 2, 3, 4, and 5 years of support was 0.6%, 2.8%, 4.0%, 5.2%, and 9.1%, respectively. Of 62 patients, 9 were observed, 27 underwent surgical revision, 15 underwent percutaneous stent implantation, 8 received a heart transplant, and 2 died before intervention. One patient underwent surgical revision and later stent implantation. The mortality with therapeutic intervention was 9/53 (17.0%). CONCLUSIONS: Although uncommon, HM 3 LVAD-supported patients might develop eOGO with an increasing incidence after 1 year of support. Although engineering efforts to reduce this complication are under way, clinicians must maintain a focus on early detection and remain vigilant.
Department of Cardiac Surgery Heart Center University of Leipzig Leipzig Germany
Department of Cardiac Surgery IRCCS Bologna S Orsola University Hospital Bologna Italy
Department of Cardiac Surgery Ludwig Maximilian University of Munich Munich Germany
Department of Cardiac Surgery Medical University of Vienna Vienna Austria
Department of Cardiology Erasmus University Medical Center Rotterdam the Netherlands
Department of Cardiology Rigshospitalet University of Copenhagen Copenhagen Denmark
Department of Cardiothoracic and Vascular Surgery German Heart Center Berlin Berlin Germany
Department of Cardiovascular Surgery Heart Center University Freiburg Bad Krozingen Freiburg Germany
Department of Health Sciences and Technology ETH Zürich Zurich Switzerland
Division of Cardiovascular Medicine University of Utah School of Medicine Salt Lake City Utah
DZHK Partner Site Berlin Berlin Germany
Faculty of Medicine University of Freiburg Freiburg Germany
King Faisal Specialist Hospital and Research Centre Riyadh Saudi Arabia
Citace poskytuje Crossref.org
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- $a Wert, Leonhard $u Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany. Electronic address: wert@dhzb.de
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- $a A multicenter evaluation of external outflow graft obstruction with a fully magnetically levitated left ventricular assist device / $c L. Wert, GC. Stewart, MR. Mehra, A. Milwidsky, UP. Jorde, DJ. Goldstein, CH. Selzman, J. Stehlik, FD. Alshamdin, FH. Khaliel, F. Gustafsson, S. Boschi, A. Loforte, S. Ajello, AM. Scandroglio, Z. Tučanová, I. Netuka, T. Schlöglhofer, D. Zimpfer, CF. Zijderhand, K. Caliskan, G. Dogan, JD. Schmitto, S. Maier, D. Schibilsky, K. Jawad, D. Saeed, G. Faerber, M. Morshuis, M. Hanuna, CS. Müller, J. Mulzer, J. Kempfert, V. Falk, EV. Potapov
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- $a BACKGROUND: The HeartMate 3 (HM 3; Abbott) left ventricular assist device (LVAD) has improved hemocompatibility-related adverse outcomes. In sporadic cases, external compression of the outflow graft causing obstruction (eOGO) can result from substance accumulation between the outflow graft and its bend relief. We sought to evaluate the prevalence, course, and clinical implications of eOGO in an international study. METHODS: A multicenter retrospective analysis of HM 3 LVADs implanted between November 2014 and April 2021 (n = 2108) was conducted across 17 cardiac centers in 8 countries. We defined eOGO as obstruction >25% in the cross-sectional area in imaging (percutaneous angiography, computed tomography, or intravascular ultrasound). The prevalence and annual incidence were calculated. Serious adverse events and outcomes (death, transplantation, or device exchange) were analyzed for eOGO cases. RESULTS: Of 2108 patients, 62 were diagnosed with eOGO at a median LVAD support duration of 953 (interquartile range, 600-1267) days. The prevalence of eOGO was 3.0% and the incidence at 1, 2, 3, 4, and 5 years of support was 0.6%, 2.8%, 4.0%, 5.2%, and 9.1%, respectively. Of 62 patients, 9 were observed, 27 underwent surgical revision, 15 underwent percutaneous stent implantation, 8 received a heart transplant, and 2 died before intervention. One patient underwent surgical revision and later stent implantation. The mortality with therapeutic intervention was 9/53 (17.0%). CONCLUSIONS: Although uncommon, HM 3 LVAD-supported patients might develop eOGO with an increasing incidence after 1 year of support. Although engineering efforts to reduce this complication are under way, clinicians must maintain a focus on early detection and remain vigilant.
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