Outflow Graft Occlusion of the HeartMate 3 Left Ventricular Assist Device.

Abstract

Continuous-flow ventricular assist devices have demonstrated clinical superiority compared with the first-generation pulsatile devices; however, complications continue to affect patients on left ventricular assist device (LVAD) support.1 The recently published MOMENTUM 3 trial (Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy With HeartMate3) reported that the HeartMate 3 (HM3) was associated with better outcomes after 6 months when compared with the HM2. None of the patients randomized to the HM3 device had suspected or confirmed thrombosis.2 In this brief report, we describe 2 patients who developed extrinsic occlusion of the outflow graft after HM3 implantation. A 65-year-old man with ischemic cardiomyopathy underwent implantation of an HM3 LVAD as bridge to transplantation. Because of significant epistaxis, acetylsalicylic acid was reduced from 325 to 81 mg daily, whereas international normalized ratio was maintained between 2 and 3. One-year post-LVAD, the patient presented with congestive symptoms and deteriorating renal function. His LVAD had logged multiple low-flow alarms, as low as 1.9 L/min (previously 4–4.5 L/min; Figure [C]). Serum lactate dehydrogenase was 290 U/L (125–220 U/L) and international normalized ratio maintained within therapeutic range. A noncontrast computed tomographic scan of the chest showed no …