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Complex stenting of an obstructed outflow graft of a heartmate 3 in an adult after a mustard procedure

Published online by Cambridge University Press:  14 July 2025

Daiji Takajo Open the ORCID record for Daiji Takajo [Opens in a new window] ,
Amr Matoq ,
Angela Lorts  and
Russel Hirsch
Daiji Takajo*
Affiliation:
Heart Institute, Cincinnati Children’s Hospital Medical Center, OH, USA
Amr Matoq
Affiliation:
Heart Institute, Cincinnati Children’s Hospital Medical Center, OH, USA
Angela Lorts
Affiliation:
Heart Institute, Cincinnati Children’s Hospital Medical Center, OH, USA
Russel Hirsch
Affiliation:
Heart Institute, Cincinnati Children’s Hospital Medical Center, OH, USA Department of Pediatrics, College of Medicine, University of Cincinnati, OH, USA
*
Corresponding author: Daiji Takajo; Email: dt1449@gmail.com
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Abstract

Ventricular assist devices, such as the HeartMate 3, are routinely used to support patents with failing ventricular function. However, extrinsic obstruction of the outflow graft has been identified as a complication associated with the HeartMate 3. We report a case of a patient with transposition of the great arteries (d-TGA), status post-Mustard procedure with severe systemic (right) ventricular dysfunction who developed extrinsic obstruction of theoutflow graft, 6 years after implant, leading to a significant reduction in HeartMate 3 flow. This patient required the placement of multiple stents to fully address the diffuse stenosis of the outflow graft. This case underscores the technical challenges involved in managing extrinsic obstruction of theoutflow graft in patients with this anatomy and highlights the importance of a tailored, multidisciplinary approach. It emphasises the need for careful planning around stent overlap, outflow graft angulation, and catheter and wire positioning in the context of complex anatomical and device-related interactions.

Keywords

extrinsic obstruction of the outflow graftventricular assist devicemustard procedure

Information

Type
Case Report
Information
Cardiology in the Young , First View , pp. 1 - 4
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Copyright
© The Author(s), 2025. Published by Cambridge University Press

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References

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Administration USFaD. Abbott/Thoratec Corp. recalls HeartMate II and HeartMate 3 left ventricular assist system (LVAS) due to potential risk of outflow graft twisting or long-term buildup causing an obstruction. Updated 04/15/2024. Accessed 12/9, 2024. https://www.fda.gov/medical-devices/medical-device-recalls/abbottthoratec-corp-recalls-heartmate-ii-and-heartmate-3-left-ventricular-assist-system-lvas-due#:∼:text=Medical%20Device%20Recalls-,Abbott%2FThoratec%20Corp.,term%20Buildup%20Causing%20an%20Obstruction&text=Please%20be%20aware%2C%20this%20recall,most%20serious%20type%20of%20recall. Google Scholar
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