Outflow Graft Narrowing of the HeartMate 3 Left Ventricular Assist Device.

作者：Sneha S. Jain, K. Clerkin, D. E. Anstey, Qi Liu, J. Fried, J. Raikhelkar, Jan M. Griffin, D. Marshall, P. Colombo, M. Yuzefpolskaya, V. Topkara, Y. Naka, K. Takeda, G. Sayer, N. Uriel, J. Leb · 发表于：Annals of Thoracic Surgery · 年份：2022 · DOI：10.1016/j.athoracsur.2021.12.014 · 被引用次数：17 · 研究领域：Medicine

BACKGROUND Outflow graft narrowing has been reported in patients with the HeartMate 3 (HM3) left ventricular assist device (LVAD) due to accumulation of biodebris either internal or external to the graft. This study describes the prevalence, imaging findings, and clinical outcomes associated with HM3 LVAD outflow graft narrowing. METHODS A single-center retrospective cohort study was performed among patients who received a HM3 LVAD between 11/2014-7/2019. All patients with a Computed Tomography (CT) Angiography or CT with IV contrast sufficient to evaluate the outflow graft lumen were included. A narrowing was defined as a hypodensity of ≥3mm. RESULTS Of 165 HM3 LVAD patients, 46 (28%) had qualifying imaging. Outflow graft narrowing was present in 33% (15/46). One patient had complete obstruction requiring emergency surgery, while 14 had a median (interquartile range) hypodensity of 4.5 mm (3.3-5.8). The presence of outflow graft narrowing was significantly associated with longer duration of LVAD support (588.2±277.5 vs. 131.5±170.9 days, p<0.0001). One-year survival after identification of narrowing was 93%, with death occurring in one patient with complete obstruction. Left ventricular (LV) unloading (mean percent decrease in LV end diastolic diameter at time of CT imaging vs. pre-LVAD) was 16.7% vs 17.7% in patients with and without narrowing, respectively (p=0.86). CONCLUSIONS Among patients with adequate imaging, one-third have evidence of narrowing. Outflow graft ...