Use of a Minimally Invasive Approach to Correct Diffuse External Compression of the Left Ventricular Assist Device Outflow Graft

Left ventricular assist devices (LVADs) implanted into patients with heart failure sometimes develop insufficient forward flow due to malfunction of the outflow graft. One increasingly seen source of outflow graft malfunction is the development of external compression of the outflow graft (ECOG) due to the accumulation of material between the flexible outflow graft and the relatively rigid overlying Gore-Tex tubular graft. When there is segmental ECOG, a percutaneous approach with outflow graft stent placement is the treatment of choice. However, we have encountered cases with diffuse ECOG for which surgery appeared to be a superior choice. We, therefore, developed a minimally invasive surgical approach in which a mini-thoracotomy, rather than redo-sternotomy, is combined with unroofing of the Gore-Tex graft and subsequent evacuation of the organized hematoma. We describe this technique in two patients with diffuse ECOG in whom we found the method to be simple, relatively rapid, and very effective.