References
- Mehra MR, Uriel N, Naka Y et al. A Fully Magnetically Levitated Left
Ventricular Assist Device - Final Report. N Engl J Med
2019;380:1618-1627.
- Uriel N, Colombo PC, Cleveland JC et al. Hemocompatibility-Related
Outcomes in the MOMENTUM 3 Trial at 6 Months: A Randomized Controlled
Study of a Fully Magnetically Levitated Pump in Advanced Heart
Failure. Circulation 2017;135:2003-2012.
- Mehra MR, Salerno C, Naka Y et al. A tale of the twist in the outflow
graft: An analysis from the MOMENTUM 3 trial. J Heart Lung Transplant
2018;37:1281-1284.
- Duero Posada JG, Moayedi Y, Alhussein M et al. Outflow Graft Occlusion
of the HeartMate 3 Left Ventricular Assist Device. Circ Heart Fail
2017;10.
- Jain P, Robson D, Shehab S et al. In vivo tissue reaction within the
outflow conduit in patients supported by HeartWare HVAD. Cardiovasc
Pathol 2020;44:107156.
- Abraham J, Remick JD, Caulfield T et al. Left ventricular assist
device outflow cannula obstruction treated with percutaneous
endovascular stenting. Circ Heart Fail 2015;8:229-30.
- Berg KB, Klodell CT. Outflow graft thrombectomy during HeartMate II
left ventricular assist device exchange. Interactive CardioVascular
and Thoracic Surgery 2014;19:714-715.Figure Legends:Figure. (A) LVAD parameters derived from device interrogation
before and at the time of low-flow alarms, (B) Cardiac CT tomography
with 3D reconstruction depicting the site of outflow obstruction (blue
arrow), (C) CT angiography 6 months prior without evidence of outflow
cannula obstruction, (D) Cardiac CT tomography (coronal axis)
suggestive of outflow cannula obstruction. Pathology panels: Cross
section of the distal outflow cannula at the bend relief shows a clot
consisting of fibrin and blood in the lumen (E) with corresponding
representative H&E section (F). Microscopic examination revealed
exuberant giant cell reaction between the Dacron and cannula (G).
Fibrin platelet material in the lumen (H) does not demonstrate
evidence of thrombus organization, confirmed by immunohistochemical
stain for vimentin (I). Cross section of the proximal outflow graft at
the bend relief shows a clot consisting of fibrin and blood in the
lumen (J) and with corresponding representative H&E section (K).
Microscopic examination revealed fibrin platelet material between the
Dacron and bend relief without evidence of giant cell reaction (L).
Clot material in the lumen demonstrated thrombus organization (M)
confirmed by immunohistochemical stain for vimentin (N).