Open AccessExtracorporeal membrane oxygenation‐assisted emergency percutaneous treatment of left ventricular assist device graft occlusion
Author(s) -
Stio Rocco Edoardo,
Montalto Andrea,
Feccia Mariano,
Intorcia Alfredo,
Buffa Vitaliano,
Cesario Vincenzo,
Petroni Giulia,
De Felice Francesco,
Musumeci Francesco
Publication year - 2021
Publication title -
esc heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.787
H-Index - 25
ISSN - 2055-5822
DOI - 10.1002/ehf2.13205
Subject(s) - medicine , extracorporeal membrane oxygenation , ventricular assist device , percutaneous , cardiology , stenosis , heart failure , occlusion , surgery , haemolysis , radiology , immunology
End‐stage heart failure is more often treated with Implantable left ventricular assist device (LVAD), even if the prolonged use may increase the risk of complications. In this case, a 51‐year‐old male patient presented to our emergency department showing acute heart failure signs and symptoms and a dramatic reduction of LVAD flow. Laboratory tests ruled out significant haemolysis, usually associated with pump thrombosis. The echocardiogram and the computed tomography were not able to clarify the correct diagnosis. We immediately placed a veno‐arterial extracorporeal membrane oxygenation, followed by a selective retrograde angiography of the pump. The images showed stenosis of the LVAD‐outflow graft, suggesting a twist. Through a hand‐made J‐tip guidewire, we performed multiple dilatations of the occlusion using peripheral balloons. Finally, we implanted an aortic coarctation covered‐stent, re‐establishing an adequate cardiac output to the patient. Our case indicates that catheter‐based approach in extracorporeal membrane oxygenation assistance provides an important therapeutic alternative to treat outflow graft stenosis, especially in the case of acutely unstable patient.