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J Chest Surg

Published online February 8, 2024

Copyright © Journal of Chest Surgery.

Surgical Correction of Left Ventricular Assist Device Outflow Graft Obstruction Caused by a Wrapped Expanded Polytetrafluoroethylene Graft: A Case Report

Sung Min Kim , M.D., Ilkun Park , M.D., Siwon Oh , M.D., Hyo Won Seo , M.D., Ga Hee Jeong , M.D., Jun Ho Lee , M.D., Ph.D., Su Ryeun Chung , M.D., Ph.D., Kiick Sung , M.D., Ph.D., Wook Sung Kim , M.D., Ph.D., Yang Hyun Cho , M.D., Ph.D.

Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Correspondence to:Yang Hyun Cho
Tel 82-2-3410-1676
Fax 82-2-3410-0089
E-mail mdcho95@gmail.com
ORCID
https://orcid.org/0000-0003-1685-3641

Received: September 22, 2023; Revised: November 23, 2023; Accepted: December 10, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A 70-year-old man with dilated cardiomyopathy underwent left ventricular assist device (LVAD) implantation, using a HeartWare ventricular assist device, as a bridge to candidacy. After 26 months, computed tomography (CT) angiography indicated stenosis in the LVAD outflow graft; however, the patient was asymptomatic, prompting a decision to manage his condition with close monitoring. Ten months later, the patient presented with dizziness and low-flow alerts. Subsequent CT angiography revealed a critical obstruction involving the entire LVAD outflow graft. The patient underwent emergency surgery, during which an organized seroma causing the graft obstruction was found between a wrapped expanded polytetrafluoroethylene (ePTFE) graft and a Dacron outflow graft. The covering of the outflow graft was removed, along with the organized seroma. Following removal of the ePTFE wrap and decompression of the outflow graft, normal LVAD flow was reestablished. The practice of wrapping the outflow graft with synthetic material, commonly done to facilitate later redo sternotomy, may pose a risk for outflow graft obstruction.

Keywords: Ventricular assist devices, Obstruction, Stenosis, Case reports

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J Chest Surg

Published online February 8, 2024

Copyright © Journal of Chest Surgery.

Surgical Correction of Left Ventricular Assist Device Outflow Graft Obstruction Caused by a Wrapped Expanded Polytetrafluoroethylene Graft: A Case Report

Sung Min Kim , M.D., Ilkun Park , M.D., Siwon Oh , M.D., Hyo Won Seo , M.D., Ga Hee Jeong , M.D., Jun Ho Lee , M.D., Ph.D., Su Ryeun Chung , M.D., Ph.D., Kiick Sung , M.D., Ph.D., Wook Sung Kim , M.D., Ph.D., Yang Hyun Cho , M.D., Ph.D.

Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Correspondence to:Yang Hyun Cho
Tel 82-2-3410-1676
Fax 82-2-3410-0089
E-mail mdcho95@gmail.com
ORCID
https://orcid.org/0000-0003-1685-3641

Received: September 22, 2023; Revised: November 23, 2023; Accepted: December 10, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A 70-year-old man with dilated cardiomyopathy underwent left ventricular assist device (LVAD) implantation, using a HeartWare ventricular assist device, as a bridge to candidacy. After 26 months, computed tomography (CT) angiography indicated stenosis in the LVAD outflow graft; however, the patient was asymptomatic, prompting a decision to manage his condition with close monitoring. Ten months later, the patient presented with dizziness and low-flow alerts. Subsequent CT angiography revealed a critical obstruction involving the entire LVAD outflow graft. The patient underwent emergency surgery, during which an organized seroma causing the graft obstruction was found between a wrapped expanded polytetrafluoroethylene (ePTFE) graft and a Dacron outflow graft. The covering of the outflow graft was removed, along with the organized seroma. Following removal of the ePTFE wrap and decompression of the outflow graft, normal LVAD flow was reestablished. The practice of wrapping the outflow graft with synthetic material, commonly done to facilitate later redo sternotomy, may pose a risk for outflow graft obstruction.

Keywords: Ventricular assist devices, Obstruction, Stenosis, Case reports

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