Urgent pump exchange for stroke resulting from a distorted HeartMate XVE inflow conduit

Long-term left ventricular assist device (LVAD) implantation is associated with an inherent risk of transient ischemic attacks (TIAs). When TIAs occur in patients who have undergone placement of a HeartMate XVE LVAD, the pump must be assumed to be the likely source of the TIA. The HeartMate XVE is unique in that it has a pumping surface of flocked Biomer and a pump housing and inlet cannula coated with sintered titanium. This design facilitates coating of the surfaces with the patient's own cells, usually within 48 hours of implantation, effectively eliminating the pumping surface as a source of thromboemboli. Similarly, neither the outflow conduit nor the porcine outflow valve have been shown to be sources of thromboemboli, as they are both subjected to the wash-out of pulsatile systolic pressure. In our experience, the only components vulnerable to pannus formation are the inflow conduit and its associated valve, and then only when the inflow conduit is distorted at implantation. We describe an illustrative case of a patient supported with a HeartMate XVE LVAD who suffered a device-related stroke that was attributed to the inflow conduit, which was distorted during implantation to configure the pump for the patient's narrow body habitus. The resultant disruption in laminar flow was the most likely cause of the TIAs and stroke. Therefore, documented TIAs in patients with an implanted HeartMate XVE are an indication for urgent pump replacement, even if pump performance is otherwise normal. In this case, the pump was exchanged for a smaller, continuous-flow HeartMate II LVAD.