Background: The HeartMate 3 (HM3, Abbott) left ventricular assist device (LVAD) is the only commercially available option considered suitable for long-term circulatory support. External compression of the outflow graft causing obstruction (eOGO) is a serious adverse event affecting patients on long-term support. The obstruction occurs due to the accumulation of gelatinous substance between the bend relief and outflow graft. This systematic review evaluated all available studies with regard to the diagnosis and therapy of eOGOs. Methods: A systematic literature review and analysis of individual patient data was performed using MEDLINE/PubMed following PRISMA guidelines. Original works dating up to 31 October 2024 were considered. Results: Twenty-four publications that met the inclusion criteria were identified, providing individual data from 113 patients with a median support time to eOGO diagnosis of 809 days [588, 1095] and follow-up after treatment of 365 days [33, 605]. eOGO severity classification was performed on 108 patients according to our grading system. For treatment, most patients underwent surgery (n = 38) or stenting (n = 29). A hazard ratio of 0.75 [0.28, 2.03] was calculated for the surgical group versus the stenting group (p = 0.570). Conclusions: Concerning 30-day mortality, we did not find a significant difference between the eOGO severity of survivors and non-survivors. We found no significant differences in outcome between patients with differing eOGO severity and treatment strategy, namely stenting and surgery. Due to an increase in eOGO incidence after one year of support, we propose that clinicians monitor their patients for this complication when support time surpasses one year.

Objectives: External compression of the outflow graft causing obstruction (eOGO) is a potentially lethal complication in patients on long‐term mechanical circulatory support with the HeartMate 3 (HM3, Abbott) left ventricular assist device (LVAD). This complication results from the build‐up of gelatinous substance between the bend relief and outflow graft and can be resolved by percutaneous intervention, surgery, or transplantation. This single‐centre follow‐up study evaluated the suitability of percutaneous intervention as a treatment strategy and long‐term outcomes of eOGO patients in terms of laboratory, LVAD, and quality‐of‐life parameters. Methods: On October 31, 2024, a search of the implantation centre's electronic database identified HM3 patients diagnosed with eOGO. Individual patient data concerning 31 cases was analyzed. A quality‐of‐life survey was conducted using the short version of the Kansas City Cardiomyopathy Questionnaire (KCCQ‐12). Results: The patient cohort had a median support time to eOGO diagnosis of 1219 days [976, 1917] and a post‐treatment follow‐up of 686 days [447, 1003]. 64.5% of patients ( n = 20) underwent percutaneous intervention showing immediate LVAD flow improvement of 0.5 L/min post‐intervention ( p = 0.04). Of eight post‐interventional survey respondents, 62.5% ( n = 5) were assigned a fair‐excellent health status according to the KCCQ‐12. Conclusions: Percutaneous intervention is a suitable treatment strategy for eOGO, resolving low flow and providing satisfactory long‐term quality of life outcomes. Given the increasing eOGO incidence after 1 year of support and overall mortality of 29.0%, clinicians should remain on high alert for this complication. We suggest computed tomography (CT) imaging be considered early on when eOGO is suspected.

Takotsubo syndrome (TTS) is a reversible form of acute heart failure characterized by apical ballooning, which may lead to cardiogenic shock (CS). When CS occurs, mechanical circulatory support (MCS) may be used to bridge patients until cardiac recovery. However, the role, optimal timing, and choice of MCS remain unclear. On February 22, 2024, a search of the clinic’s electronic database was performed for patients diagnosed with TTS. The search yielded 47 patients, with 9 patients receiving MCS. Individual patient data concerning these 9 cases were extracted and analyzed. Of 9 TTS patients with MCS, 5 were supported by an Impella system, with the remaining 4 patients receiving a combination of Impella and extracorporeal membrane oxygenation. Left ventricular ejection fraction measured at admission ranged from 10% to 36%, with 4 patients showing full recovery of left ventricular ejection function. Three patients died in the hospital and 1 patient remains on long-term support with a HeartMate 3 left ventricular assist device. This retrospective single–center study on the use of MCS in TTS management supports results from previous studies reporting on the benefit of Impella therapy. Our experience shows that Impella support provides stabilization of CS and unloading of the left ventricle, allowing full recovery of left ventricular function and reversing TTS findings. For patients who do not adequately respond to Impella support alone, escalation to a combination of Impella and extracorporeal membrane oxygenation strategy is feasible to further improve cardiac output, while protecting the left ventricle from the increased afterload.