Percutaneous Intervention With Cerebral Protection in LVAD Outflow Graft Obstruction

Among certain patients with left ventricular assist devices (LVAD) outflow graft obstruction, percutaneous intervention is an acceptable alternative and less invasive than surgical pump replacement, and the use of a catheter-based cerebral protection system may lower the occurrence of associated embolism. These findings were published in Catheterization & Cardiovascular Interventions.

Researchers sought to investigate the efficacy of the Sentinel cerebral protection system (CPS) among patients with LVAD outflow graft obstruction receiving percutaneous intervention. To accomplish this, they conducted a retrospective case-series analysis of 6 patients (median aged 56.5 years at implantation from 2013 through 2018; 33% women; 100% Black) with LVAD outflow graft obstruction selected from among 501 LVAD patients with implants from a single institute. Four of these patients had a HeartMate-III LVAD, 1 patient had HeartMate-II LVAD, and 1 patient had HeartWare (HVAD).  

Median time from LVAD implantation to LVAD outflow obstruction was 1343 days, and 934 days for the 4 LVAD HeartMate-III implants. Thrombus or debris was removed in all patients with the use of the Sentinel CPS. Among these patients, 1 with suspected thrombosis of LVAD developed a recurrence of LVAD outflow graft stenosis.

Study limitations include stenting of the outflow graft was accomplished with no cerebral protection and the rate of periprocedural stroke during such stenting is unknown. Also, the concomitant use of thrombolytics associated with intracranial hemorrhage.

The researchers wrote, “Percutaneous intervention of LVAD outflow graft obstruction is less invasive than surgical pump exchange and an acceptable alternative in properly selected patients.” Researchers added that their experience suggests that using a catheter-based CPS may help lower the occurrence of embolism before, during, or after percutaneous intervention.

Reference

Joury A, Patel RAG, Wever-Pinzon J, et al. Cerebral protection during percutaneous intervention for left ventricular assist device outflow graft obstruction. Catheter Cardiovasc Interv. Published online May 25, 2022. doi:10.1002/ccd.30241