Kinking of the Outflow Graft, Consequent Ventricular Tachycardia, and the Need for Reoperation in a Patient with Left Ventricular Assist Device

Authors

  • Dusko Terzic Department for Heart Transplant, LVAD and ECMO, Clinic for Cardiac Surgery, Clinical Center of Serbia, Belgrade, Serbia
  • Emilija Nestorovic Department for Heart Transplant, LVAD and ECMO, Clinic for Cardiac Surgery, Clinical Center of Serbia, Belgrade, Serbia
  • Svetozar Putnik Department for Heart Transplant, LVAD and ECMO, Clinic for Cardiac Surgery, Clinical Center of Serbia, Belgrade, Serbia
  • Dejan Markovic Department for Heart Transplant, LVAD and ECMO, Clinic for Cardiac Surgery, Clinical Center of Serbia, Belgrade, Serbia
  • Miljko Ristic Department for Heart Transplant, LVAD and ECMO, Clinic for Cardiac Surgery, Clinical Center of Serbia, Belgrade, Serbia

DOI:

https://doi.org/10.1532/hsf.1848

Keywords:

LVAD, outflow graft, kinking, Ventricular tachycardia

Abstract

Background: Left ventricular assist devices (LVAD) have become a lifesaving solution for patients awaiting heart transplantation as well as an option to support the failing hearts of non-transplant candidates as a lifelong, or destination therapy (DT). Improvements in LVAD design have enabled greater durability and broader patient applicability, but not without complications. Ventricular arrhythmias in LVAD patients were considered benign in the early days of LVADs, but today are increasingly recognized for their harmful impact on morbidity and quality of life.

Case presentation: We describe a 53-year-old male who underwent HeartWare left ventricular assist device (HVAD) implantation. During the postoperative period, the patient experienced ventricular tachycardia (VT) during a coughing episode, later found on CT to be due to significant angulation of the outflow graft. Following reoperation to shorten the outflow graft, the patient returned to hemodynamic stability, without VT or other arrhythmias.

Conclusions: Innovative strategies in VT prevention and improved clinical outcomes in LVAD patients may be the result of better understanding of characteristics that predispose these patients to VT. This case report showed that an excessively long outflow graft with considerable kinking created significant VT, but reoperation to correct the length of the graft mitigated further VT complications.

Author Biography

Dusko Terzic, Department for Heart Transplant, LVAD and ECMO, Clinic for Cardiac Surgery, Clinical Center of Serbia, Belgrade, Serbia

Department for heart transplant ,LVAD and ECMo

Clinic for cardia surgery

Clinical Center of Serbia

References

Connellan M, Muthiah K, Robson D, et al. 2013. Pressure and flow sequelae to kinking of the heartware HVAD outflow graft. J Heart Lung Transplant 32:S280.

Griffin JM, Katz JN. 2014. The burden of ventricular arrhythmias following left ventricular assist device implantation. Arrhythm Electrophysiol Rev 3:145-8.

Nakahara S, Chien C, Gelow J, et al. 2013. Ventricular arrhythmias after left ventricular assist device. Circ Arrhythm Electrophysiol 6:648-54.

Vollkron M, Voitl P, Ta J, et al. 2007. Suction events during left ventricular support and ventricular arrhythmias. J Heart Lung Transplant 26:819-25.

Ziv O, Dizon J, Thosani A, Naka Y, Magnano AR, Garan H. 2005. Effects of left ventricular assist device therapy on ventricular arrhythmias. J Am Coll Cardiol 45:1428-34.

Published

2017-08-24

How to Cite

Terzic, D., Nestorovic, E., Putnik, S., Markovic, D., & Ristic, M. (2017). Kinking of the Outflow Graft, Consequent Ventricular Tachycardia, and the Need for Reoperation in a Patient with Left Ventricular Assist Device. The Heart Surgery Forum, 20(4), E139-E141. https://doi.org/10.1532/hsf.1848

Issue

Vol. 20 No. 4 (2017)

Section

Article
Author Disclosure & Copyright Transfer Agreement