To Stent or not to stent – a Case Report on Left Ventricular assist Device outflow Graft Stenosis

Left ventricular assist devices (LVADs) have evolved from a bridge to heart transplantation to a more common destination therapy for end-stage heart failure. Complications such as outflow graft stenosis, with a reported probability of 6% at 5 years post-LVAD support, pose significant challenges. Emergent surgical decompression or cardiac transplant are typical therapies, with few reports on outflow graft stenting, none involving the BeGraft® aortic stent. A 68-year-old man with a HeartMate 3TM LVAD presented with recurrent low-flow alarms two years post-implantation. CT angiography revealed high-grade outflow graft stenosis near the ascending aorta. Intervention involved percutaneous femoral access, deployment of a BeGraft Aortic stent, and subsequent observation in the intensive care unit (ICU). Post-intervention CT angiography showed patent outflow graft, with discharge occurring after eight days without complications. Endovascular techniques offer low-risk, high-survival solutions for complex LVAD-related complications, like outflow graft stenosis. Our case highlights successful use of the BeGraft® aortic stent, offering high radial force and post-dilation options. Careful patient selection and evaluation are essential for optimal outcomes in endovascular treatment of outflow graft stenosis.