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Published on: May 11, 2018
Durable Left-Ventricular Assist Device Inflow Thrombosis Following External Outflow Graft Obstruction
Mohammad J Malik1, Jin Woo Chung1, Matthias Loebe1
1Division of Cardiothoracic Surgery, University of Kentucky Healthcare, Lexington, Kentucky, USA.
Background:
External outflow graft obstruction (EOGO) is an emerging complication due to improved pump durability. We experienced a rare sequence of complications, inflow thrombus formation following EOGO with reduced left-ventricular assist device flow.
Case Summary:
A 41-year-old man, 2 years post HeartMate 3 (HM3) implantation, presented with low-flow from EOGO. Outflow graft stenting resulted in improvement but returned 1 month later with persistent low flow. Pump thrombosis was excluded. Flow had minimal response to RPM increase. Outflow graft was widely patent. Inflow obstruction was suspected, and HM3-to-HM3 exchange revealed extensive thrombus formation within the inflow cannula. Left-ventricular assist device flow returned to normal. Postoperative recovery was uneventful.
Discussion:
The cause of this inflow thrombus formation, an extremely rare complication, was suspected to be from EOGO low flow.
Take-Home Messages:
Inflow thrombosis should be included in the differential diagnosis with low flow. EOGO low flow could cause secondary inflow thrombosis.
