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. Author manuscript; available in PMC: 2018 Feb 8.
Published in final edited form as: J Invasive Cardiol. 2017 Feb 15;29(5):151–162.

Table 2.

Percutaneous therapies for outflow graft stenosis.

Author Year Case Series Indication/Diagnosis Intervention Outcome Long-Term Outcome
Ganapathi et al79 2013 1 patient with HMII
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    Presented with worsening heart failure symptoms

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    CT scan showed 13cm pseudoaneurysm of outflow graft
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    Gore Excluder (Gore Medical) iliac limb stent-graft (16 mm proximal diameter, 18 mm distal diameter × 9.5 cm length) deployed in the HMII outflow graft excluding the pseudoaneurysm via left axillary approach
  • -

    Patient discharged with improvement in heart failure symptoms

  • -

    Follow-up imaging at 6 mo. showed well-positioned stent-graft without endoleak and with complete resolution of pseudoaneurysm
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    Patient doing well at 10 months post procedure
Retzer et al78 2015 1 patient with HVAD
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    Symptoms of persistent heart failure

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    Slow decrease in flows with reduced pulsatility

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    Outflow graft stenosis (90%) with 120 mm Hg gradient across the lesion For on left heart cath and direct outflow graft pressure measurements
  • -

    Series of balloon dilations followed by placement of 10 × 38 mm Atrium iCAST stent (Maquet Gettinge Group)

  • -

    Balloon-expandable stainless-steel stent
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    Immediate improvement in LVAD flows and reduction of the gradient to 30 mm Hg with subsequent improvement in renal function and right ventricular function

  • -

    Discharged to rehab
  • -

    Not reported
Abraham et al82 2015 1 patient with HMII
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    Presented with low-flow alarms and dyspnea

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    TTE showed aortic valve opening with each beat

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    CT with contrast of the Personal chest showed narrowing of the outflow graft with extensive thrombus
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    Left brachial artery cutdown

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    Kumpe catheter (AngioDynamics) placed retrograde into outflow graft

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    A 9 × 59 mm Atrium stent deployed in the cannula while LVAD speed reduced to 6000 rpm
  • -

    Flows improved after stent was deployed

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    Patient discharged 4 days later on coumadin
  • -

    1-month follow-up CT scan showed intact stents and only mild residual thrombus
Hanke et al 83 2015 1 patient with HVAD (history of 2 exchanges previously)
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    Development of dyspnea on exertion

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    Increased HVAD power levels

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    CT chest showed severe outflow graft thrombosis
  • -

    Atrium 12 × 61 mm aortic stent deployed in the outflow graft and dilated by a balloon to 8 atm.

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    12 mm balloon into the right brachiocephalic trunk and embolic protection filter in left carotid artery
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    Extubated in the operating room, improvement in hemodynamic parameters

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    CT scan 2 days later showed no restenosis

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    Discharged on postoperative day 8
  • -

    Developed hemolysis 6 months after the procedure – LVAD turned off

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    Heart transplant 9 mo. post procedure
Hubbert et al 84 2016 1 patient with HMII
  • -

    Acute low flow pump alarm

  • -

    TTE showed low flow velocity in the outflow graft (0.4 m/s) - CT angiography showed thrombosis in the outflow graft
  • -

    26 Fr destination (90 cm) introducer used to place 7 mm SpiderFX carotid filter Only (Covidien) in distal common carotid arteries bilaterally

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    Initial dilation with 4 × 40 mm PTA balloon, then deployment of Excluder endoprosthesis (Gore Medical) and post dilation with 14 × 40 mm PTA balloon
  • -

    Immediate improvement in LVAD flows

  • -

    TTE confirmed rise in velocity in the outflow graft

  • -

    Patient suffered subarachnoid hemorrhage 1 week after procedure. Recovered without neurologic sequelae
  • -

    No long-term follow-up
Wiedermann et al80 2016 3 patients with HVAD
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    Symptoms of heart failure

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    Decrease in power consumption in HVAD log files

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    CT angiography chest showed stenosis of the distal outflow graft
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    Consecutive percutaneous transcatheter angioplasty followed by implantation of Smart Control 12 × 40 stent
  • -

    HVAD log files showed increased flow and power consumption

  • -

    Symptomatic improvement
  • -

    Not reported

TTE = transthoracic echocardiogram; HVAD = HeartWare ventricular assist device; HMII = HeartMate II; CT = computed tomography; PTA = percutaneous transluminal angioplasty; mo. = months.