Percutaneous Stenting of LVAD Outflow Graft Obstruction: A Multimodality Imaging Case Series

BACKGROUND: Outflow graft obstruction (OGO) is an increasingly recognized complication of continuous-flow left ventricular assist devices (CF-LVADs), particularly the HeartMate 3. Surgical revision is often high risk, and percutaneous alternatives are emerging. AIMS: To evaluate the feasibility, safety, and outcomes of endovascular stenting for the treatment of LVAD OGO using a multimodality imaging approach. METHODS: We retrospectively reviewed all HeartMate 3 patients undergoing percutaneous treatment of OGO at our institution between September 2023 and April 2025. Clinical presentation, multimodality imaging findings, procedural characteristics, and outcomes were analyzed. RESULTS: Eight patients underwent endovascular intervention. All presented with persistent low-flow alarms and variable syncope or neurologic symptoms. Technical success was achieved in all cases. Median LVAD flow improved from 2.8 L/min pre-intervention to 4.4 L/min post-intervention. Two access-related bleeding complications and one hemothorax occurred, all managed successfully. At a median follow-up of 7 months, no recurrent OGO was observed. CONCLUSIONS: Endovascular stenting guided by multimodality imaging is a feasible and effective alternative to surgical revision for LVAD OGO in selected patients.