Long-Term Results After Interventional Treatment of Outflow Graft Obstruction in LVAD Patients

All articles of this category (opens in new window) Background: Outflow graft obstruction (OGO) caused by extrinsic compression is a late complication after left ventricular assist device (LVAD) implantation. Recently, stent graft implantation has emerged as a feasible treatment option. While short-term results are encouraging, evidence for long-term efficacy remains scarce. We propose a structured diagnostic algorithm for follow-up and report long-term outcomes after interventional treatment of OGO. Methods: Between January 2015 and June 2025, 511 consecutive patients underwent LVAD implantation at our institution. Relevant OGO (clinical impairment accompanied by low-flow alarms or by critical stenosis defined as > 70% outflow graft narrowing on computed tomography) was observed only in patients supported with HeartMate3 LVAD (Abbott, Illinois, United States), with an incidence of 4.5% ( n = 23). Eleven patients, who were followed up at least 2 years after interventional OGO treatment, were included in this analysis. Results: Six patients had dilated cardiomyopathy, and five patients had ischemic heart disease as the primary underlying cause of advanced heart failure. The median LVAD support time until OGO diagnosis was 1,274 days (range: 555–2,316). Most patients were male ( n = 9; 82%) and received LVAD as destination therapy ( n = 7; 64%). The mean age at the time of percutaneous intervention was 63.4 years (range: 36–77). The median number of implanted stents (GORE Viabahn VBX, Arizona, United States) per patient was 3 (range: 2–4). The procedure was successful in all patients. The follow-up assessments primarily consist of clinical signs, laboratory testing, LVAD analysis, and echocardiography. Computed tomography and invasive procedures in terms of angiography were repeated only in cases of suspected OGO recurrence. After a median follow-up of 1,038 days (range: 152–1,329), two patients died (152 days after the intervention due to COVID-19-related acute respiratory distress syndrome and 887 days after stenting due to sepsis), and one patient underwent heart transplantation 669 days after the procedure. Re-intervention due to significant stent re-stenosis was necessary in one patient, 601 days after initial stenting. The remaining seven patients are in routine follow-up with stable LVAD parameters and without clinical signs of restenosis. Conclusion: Interventional treatment for OGO is a safe procedure and shows promising long-term results. Thus, this is a viable, less invasive alternative to redo surgery, especially in high-risk, elderly LVAD patients. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany