Aortic Root Thrombus Complicating Left Ventricular Assist Device Implantation

Abstract

<h3>Introduction</h3> Aortic root thrombus (ART) is a recognized complication associated with left ventricular assist devices (LVADs) and is associated with significant morbidity and mortality. <h3>Case Report</h3> A 49 year-old male with recently diagnosed non-ischemic cardiomyopathy on inotropic support underwent HeartMate 3 implantation. He initially did well, but subsequently deteriorated and had altered mental status. CT head revealed vertebral artery thrombus and multiple ischemic changes. TEE showed large thrombus on aortic valve (AV) extending into the right coronary artery (RCA) despite therapeutic anticoagulation(Figure 1B). Hypercoagulable work up showed positive lupus anti-coagulant. He had progressive RV failure requiring right ventricular assist device as well as intractable ventricular fibrillation. Decision was made to list status 1 for heart transplant and suitable donor was identified within 72 hours. Post-operatively, unresponsive off sedation with dysconjugate gaze and minimal reflexes. Head CT showed extensive infarcts with swelling and mass effect. He was transitioned to comfort measures and compassionately extubated. <h3>Summary</h3> ART remains a rare, but significant complication post-implant despite improvements in contemporary LVADs. Pre-implant hypercoagulable workup in all patients has shown low utility. This case highlights the importance of intermittent AV opening and the significant complications that can occur in LVAD patients with ART.