Heartmate 3 Left Ventricular Assist Device Bend Relief Disconnection Causing Laceration of the Outflow Graft

As technology in mechanical circulatory support continues to advance, so does the utilization of durable left ventricular assist devices (LVADs). We present the first reported case of HeartMate 3 (HM3) LVAD bend relief disconnection causing laceration of the outflow graft. Our patient is a 34 year old male with end-stage heart failure status post-HM3 implantation with recent debridement of a driveline infection who presented with weakness and sanguineous drainage 5 days after an episode of heavy lifting associated with a palpable substernal pop. During the initial evaluation, he experienced sudden massive decompression of a left chest hematoma through a thoracotomy incision with exsanguinating hemorrhage and an abrupt drop in LVAD flow. An emergent anterolateral thoracotomy was performed where it was discovered that the bend relief was disconnected and had lacerated the outflow graft. The graft was repaired and the ring was removed using a diamond blade rotary saw. He was discharged home and made a full recovery. Mechanical device malfunction has been documented in several prior versions of durable LVADS. Although there have been reported cases in the Heartmate 2, this is the first reported case of a HM3 bend relief disconnection and resultant laceration of the outflow graft.