Background
The use of polytetrafluoroethylene (PTFE) material as a protective cover for left
ventricular assist device (LVAD) outflow grafts (OG) is a common practice. However,
it has descriptively been linked to the development of blood flow obstruction (BFO).
Methods
Patient data from 194 consecutive HVAD (Medtronic Inc; Medtronic, Minneapolis, MN)
recipients implanted between March 2006 and January 2021 were retrospectively analyzed.
PTFE covers were used in 102 patients. Study outcomes included the incidence of BFO
and survival on LVAD support.
Results
Thirty-seven patients (19.1%) developed BFO during the study period. On a multivariable
Cox regression analysis, PTFE use was an independent predictor for the development
of BFO (HR 2.15, 95% CI 1.03-4.48, p = .04). BFO comprised of 2 types of device malfunction: eleven patients (5.7%) developed
outflow graft stenosis (OGS), and 31 patients (16.0%) developed pump thrombosis (PT).
There was a significantly higher cumulative incidence of OGS in patients with PTFE
cover than in those without (Gray's test, p =.03). However, the observed higher cumulative incidence of PT in PTFE patients was
non-significant (Gray's test, p =.06). In a multivariable Cox regression model, the effect of PTFE use on survival
was non-significant (HR 0.95, 95% CI 0.60-1.48, p =.81), while the development of BFO was independently associated with increased mortality
(HR 3.43, 95% CI 1.94-6.06, p < .0001).
Conclusions
The use of PTFE OG cover in LVAD patients is associated with an increased cumulative
probability of development of BFO, the latter adversely impacting survival and is
therefore, harmful.
KEYWORDS
Abbreviations:
BFO (blood flow obstruction), BMI (body-mass-index), CI (confidence interval), CIF (cumulative incidence function), GEE (generalized estimating equations), HR (hazard ratio), HTx (heart transplant), INTERMACS (interagency registry of mechanically assisted circulatory support), LVAD (left ventricular assist device), OG (outflow graft), OGS (outflow graft stenosis), PT (pump thrombosis), PTFE (polytetrafluoroethylene)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 20, 2022
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