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The Journal of Heart and Lung Transplantation
International Society for Heart and Lung Transplantation.

Strategy for surgical correction and mitigation of outflow graft twist with a centrifugal-flow left ventricular assist system

      A fully magnetically levitated centrifugal-flow left ventricular assist system (LVAS) has been introduced, with demonstration of improved hemocompatibility and reduced rates of pump malfunction, and stroke.
      • Mehra M.R.
      • Goldstein D.J.
      • Uriel N.
      • et al.
      MOMENTUM 3 Investigators
      Two-year outcomes with a magnetically levitated cardiac pump in heart failure.
      • Netuka I.
      • Sood P.
      • Pya Y.
      • et al.
      Fully magnetically levitated left ventricular assist system for treating advanced HF: a multicenter study.
      • Mehra M.R.
      • Naka Y.
      • Uriel N.
      • et al.
      MOMENTUM 3 Investigators
      A fully magnetically levitated circulatory pump for advanced heart failure.
      • Netuka I.
      • Kvasnička T.
      • Kvasnička J.
      • et al.
      Evaluation of von Willebrand factor with a fully magnetically levitated centrifugal continuous-flow left ventricular assist device in advanced heart failure.
      This LVAS, the HeartMate 3 (Abbott, Abbott Park, IL) pump, has been observed to have isolated cases of an outflow graft twist occurring in follow-up periods, later in the course of support.
      • Mehra M.R.
      • Goldstein D.J.
      • Uriel N.
      • et al.
      MOMENTUM 3 Investigators
      Two-year outcomes with a magnetically levitated cardiac pump in heart failure.
      • Grüger T.
      • Kaufmann F.
      • Dreysse S.
      • et al.
      Late post-pump blood flow obstruction in a novel left ventricular assist device: the unusual case of a twisted outflow graft.
      The mechanism for this development is incompletely understood. It may, however, be related to the proximal outflow graft metallic swivel joint that allows relatively free rotation of this graft once implanted (Figure 1), which is designed to allow initial repositioning during surgery to correct any torque, twist, or kink.
      Figure 1
      Figure 1Outflow graft connector mechanism (image obtained courtesy of Abbott, Inc.)
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      References

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        • Goldstein D.J.
        • Uriel N.
        • et al.
        • MOMENTUM 3 Investigators
        Two-year outcomes with a magnetically levitated cardiac pump in heart failure.
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        • Netuka I.
        • Sood P.
        • Pya Y.
        • et al.
        Fully magnetically levitated left ventricular assist system for treating advanced HF: a multicenter study.
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        • Mehra M.R.
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        • Uriel N.
        • et al.
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        A fully magnetically levitated circulatory pump for advanced heart failure.
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        • et al.
        Evaluation of von Willebrand factor with a fully magnetically levitated centrifugal continuous-flow left ventricular assist device in advanced heart failure.
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