Percutaneous management and outcomes of outflow graft obstruction in patients with left ventricular assist device: A single-center experience.

Background: Outflow graft obstruction (OGO) is a rare but potentially fatal complication of left ventricular assist device (LVAD) therapy. Timely diagnosis and intervention are critical to prevent hemodynamic compromise and death. Methods: We retrospectively reviewed 191 LVAD patients treated between January 2016 and April 2025. Seven (3.66%) had imaging-confirmed OGO. One died before intervention; 6 underwent intravascular ultrasound (IVUS)-guided stenting. LVAD flows, pressure gradient, and 12-month survival were analyzed. Results: Patients had a mean age of 59.0 ± 13.8 years with a mean LVAD support duration of 63.6 ± 25.3 months. After stenting, mean LVAD flow improved from 1.98 to 4.70 L/min (p = 0.006), while gradients decreased from 74.67 to 31.67 mmHg (p = 0.027). No major complications occurred; all were discharged on warfarin and clopidogrel. The 12-month survival was 83.3% with 2 hemorrhagic strokes. Conclusion: Intravascular ultrasound-guided stenting of OGO is safe and effective. Timely intervention may improve survival. Further research is needed for optimal antiplatelet strategies in LVAD patients undergoing stenting for OGO.