Outcomes of outflow graft stenting in HeartMate 3 left ventricular assist devices: A systematic review and individual patient data meta-analysis.

Authors

• Sanath Patil
• Danial Ahmad
• Kishori Shah
• Alec Vishnevsky
• Nicholas J Ruggiero
• Indranee N Rajapreyar
• J Eduardo Rame
• Rene J Alvarez
• Keshava Rajagopal
• John W Entwistle
• Howard T Massey
• Vakhtang Tchantchaleishvili

Publication/Presentation Date

6-1-2024

Abstract

PURPOSE: LVAD outflow graft stenosis continues to remain prevalent with a high complication rate. We sought to pool the existing evidence on indications, utilization patterns, and outcomes of transcatheter interventions for outflow graft stenosis in the HeartMate 3 LVAD.

METHODS: An electronic search was performed to identify all studies in the English literature reporting on HeartMate 3 LVAD outflow graft stenting. Patient-level data were extracted for analysis.

RESULTS: Thirteen published reports and one unpublished case comprising a total of 28 patients were included. Median patient age was 68.5 years [Interquartile range: 58, 71] and 25.9% (7/27) were female. Dyspnea [60.7% (17/28)] was the most common presenting symptom. Low flow alarms were present in 60% (15/25) of patients. Findings included external compression [35.7% (10/28)], graft twist [21.4% (6/28)], graft twist and external compression [14.3% (4.28)], intraluminal thrombus [10.7% (3/28)], graft twist and intraluminal thrombus [3.6% (1/28)], and pseudoaneurysm of outflow graft [3.6% (1/28)]. Median time from LVAD implantation to stenting was 2.1 years [1.4, 3]. Immediate flow normalization after stenting was observed in 85.7% (24/28). The 30-day mortality was 12% (3/25). Overall mortality was 12% (3/25) at a median follow-up of 3.9 months [1, 17].

CONCLUSION: Outflow graft stenting in the HeartMate 3 LVAD appears to be a reasonable treatment option for outflow graft stenosis, with low overall rates of complications and mortality. Further refinement of indications and approaches may improve outcomes.

Volume

48

Issue

6

First Page

577

Last Page

585

ISSN

1525-1594

Published In/Presented At

Patil, S., Ahmad, D., Shah, K., Vishnevsky, A., Ruggiero, N. J., Rajapreyar, I. N., Rame, J. E., Alvarez, R. J., Rajagopal, K., Entwistle, J. W., Massey, H. T., & Tchantchaleishvili, V. (2024). Outcomes of outflow graft stenting in HeartMate 3 left ventricular assist devices: A systematic review and individual patient data meta-analysis. Artificial organs, 48(6), 577–585. https://doi.org/10.1111/aor.14736

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

38577853

Department(s)

Administration and Leadership

Document Type

Article