Successful Percutaneous Management of LVAD Outflow Graft Stenosis: Role of Invasive Hemodynamics in Decision Making

Left ventricular assist device (LVAD) outflow graft stenosis (OGS) is a rare but lethal complication. We present a case of a 79-year-old male with pertinent past medical history of an LVAD implanted as destination therapy, stage III chronic kidney disease, and hypertension. He was admitted for low-flow alarms, and the echocardiogram showed stable right ventricle function and no pericardial effusion. Invasive hemodynamic assessments demonstrated a peak-to-peak gradient of 90 mm Hg in the outflow graft between the mid and distal ends of the graft on pullback. Contrast angiography confirmed OGS. The OGS was successfully treated with a VBX-covered stent (Gore). OGS should be considered when low flow alarms are found in patients with LVADs

Saddle Pulmonary Embolus Caught in Transit across a Patent Foramen Ovale

Impending paradoxical embolism (IPE) also described in the literature as thrombus straddling a patent foramen ovale (PFO) or paradoxical embolus in transit is a rare condition when thrombus (originating mostly in deep veins of lower extremities) embolized to the heart gets caught in PFO or in atrial septal defect without systemic embolization. We present a case of a 39-year-old female on oral contraceptive pills who presented to the emergency department with chief complaint of dyspnea and chest pain. She was found to have saddle pulmonary embolus (PE) extending through PFO to left atrium and into the left ventricle. Patient underwent emergent open pulmonary embolectomy, removal of right and left atrial thrombi, and closure of patent foramen ovale. She tolerated the surgery well and was discharged home on chronic anticoagulation therapy

Acute Pump Thrombosis within One Hour of a HeartMate 3 Implantation: Case Report

A 39-year-old male with a history of non-ischemic cardiomyopathy underwent a HeartMate 3 (Abbott Laboratories) implantation. Within an hour of implantation, low flow alarms were noted before exiting the operating room. The alarm was secondary to acute pump thrombosis. This is the first reported case of thrombosis immediately post-implant

Successful pregnancy with centrifugal flow left ventricular assist device: A case report and review of the literature

Successful deliveries from patients supported by axial flow left ventricular devices have been previously reported. We present the first case of a successful pregnancy and birth in a patient with a centrifugal-flow left ventricular assist device. A 24-year-old female with methamphetamine-induced cardiomyopathy and end-stage congestive heart failure supported by a HeartWare™ ventricular assist device (Medtronic) presented two years after device implantation with an unplanned pregnancy at 11-weeks of gestation. Following a multidisciplinary evaluation by experts in advanced heart failure, maternal fetal medicine, cardiothoracic surgery, anesthesia, ethics, psychiatry, and palliative care, an advanced plan of care was established. An elective induction of labor was scheduled for the 34th week of gestation. Given poor labor progression despite maximal induction efforts, the patient was transferred to a cardiothoracic operating room where she delivered a healthy baby boy via Cesarean section under close hemodynamic monitoring by advanced heart failure and cardiothoracic surgery teams

Outcomes in Patients with Chronic Kidney Disease and End Stage Renal Disease and Durable Left Ventricular Assist Device: Insights from United States Renal Data System Database

BACKGROUND: There is paucity of data regarding durable LVAD outcomes in patients with chronic kidney disease (CKD) stage 3-5 and CKD stage 5 on dialysis (ESRD: end stage renal disease). METHODS: We conducted a retrospective study of Medicare beneficiaries with ESRD and 5% sample of CKD with LVAD (2006 to 2018) to determine one-year outcomes utilizing the United States Renal Data System (USRDS) database. The LVAD implantation, comorbidities and outcomes were identified using appropriate ICD-9 and ICD-10 codes. RESULTS: We identified 496 CKD and 95 ESRD patients who underwent LVAD implantation. The ESRD patients were younger (59 vs 66 years; p CONCLUSIONS: Patients with ESRD undergoing LVAD implantation had significantly higher index and 1-year mortality compared to CKD patients