The Journal of Thoracic and Cardiovascular Surgery
Adult: Mechanical Circulatory SupportA multicenter evaluation of external outflow graft obstruction with a fully magnetically levitated left ventricular assist device
Graphical abstract
Section snippets
Study Design
This was a multicenter, retrospective study for which we collected data from patients supported with a fully magnetically levitated centrifugal-flow HM 3 LVAD. The study was approved by the institutional review board of each of the 17 participating centers in Austria, the Czech Republic, Denmark, Germany, Italy, Saudi Arabia, the Netherlands, and the United States. The authors vouch for the complete and accurate acquisition of all the data, the validity of the results, and the conclusion. The
Patients
Seventeen centers participated in this study. From June 2014 through March 2021, a total of 2108 patients received an implanted HM 3 LVAD, and of these, 62 patients (2.9%) were diagnosed with eOGO during the course of the study period. The mean support time until the eOGO diagnosis was 953.4 ± 462.5 days, and baseline characteristics and detailed surgical techniques used are described in Table E1 and Table 1. A full sternotomy was performed in most of the patients (83.87%). In 56 patients the
Discussion
The principal findings of this international collaborative analysis suggest that eOGO occurs sporadically, varies in prevalence and incidence according to center, and has an overall prevalence of 3.0%. Importantly, this complication has an increasing incidence as time of LVAD support grows. We confirm that the overall incidence is comparable with that previously reported.10 Recently published data from large registries show that the overall survival of eOGO patients is similar to that of all
Conclusions
eOGO caused by compression of gelatinous substance between the outflow graft and the bend relief is an uncommon but potentially life-threatening complication in HM 3 LVAD patients who require prolonged support (Figure 6). These findings suggest that centers should develop a standardized strategy of surveillance to screen HM 3 LVAD patients for eOGO and that imaging should be performed without delay when this complication is suspected. Although engineering efforts to reduce this complication are
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