Diagnosis of Left Ventricular Assist Device Outflow Graft Obstruction Using Intravascular Ultrasound

Originally conceived of as a means for bridging patients to heart transplantation, the encouraging long-term outcomes of left ventricular assist devices (LVADs) have led to their increased use in the treatment of heart failure, even in cases where transplant candidacy or availability is unlikely. Despite the life-saving aspects of LVAD therapy to support the patient with end-stage heart failure, issues of pump obstruction and thrombosis persist, resulting in an increasing need for emergent device exchanges or deaths from thrombosis.1 This forms a diagnostic dilemma for care providers because there are a variety of clinical syndromes that may mimic this feared complication, yet the treatment options for bona fide pump thrombosis are limited. Although algorithms have been proposed to address this problem in a standardized fashion,2 there remains considerable heterogeneity in the diagnosis and management of pump thrombosis between centers. Where outflow graft obstruction is suspected, vascular ultrasound has previously been used intraoperatively to confirm the presence of outflow graft obstruction.3 However, intravascular ultrasound (IVUS) offers the benefit of confirming obstruction before taking the patient to the operating suite for device exchange. We present a case of HeartMate II LVAD (Thoratec Corporation, CA) thrombosis in which IVUS was used in this very manner; the first reported case of its kind. A 65-year-old female (62 kg) with …