Background: Owing to a shortage of heart donors and the increasing prevalence of end-stage heart failure (HF), left ventricular assist device (LVAD) therapy is expanding, while LVAD complications, including outflow graft (OG) obstruction (OGO), significantly affect patients' prognosis.
Case summary: We present a 70-year-old ischemic HF male 2.5 years after HeartMate3 implantation. At admission, exertion dyspnea, peripheral edema, and occasional LVAD alarms were observed, which subsequently intensified. The multimodality imaging revealed OGO. The OG stent-graft implantation was performed, but after patency restoration, a critical narrowing appeared, which was successfully managed with balloon angioplasty. The LVAD function and 2.5-year follow-up were uneventful.
Discussion: The percutaneous OGO management in HeartMate3 patients was described by a few authors, mostly with mid-term follow-up.
Take-Home Messages: OGO may require multimodality imaging and management, including multi-specialty procedures. Stent-graft implantation and OG ballooning appear to be a feasible treatment option for OGO, with a good long-term outcome.
JACC Case Reports Interim Editors-in-Chief
Gilbert H. L. Tang, MD, MSc, MBA
CME Editor
Kenneth A. Ellenbogen, MD
Author
Ioannis Dimarakis, MD, PhD
Important Dates
Date of Release: January 7, 2026
Term of Approval/Date of CME/MOC Expiration: January 6, 2027