Successful Prevention of Aortic Root Thrombosis Following Left Ventricular Assist Device Implantation Using Outflow Graft-Aortic Root Bypass.
Hironobu Sakurai, Kota Suzuki, Kohei Tonai et al.
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Case in brief
A 59-year-old man with dilated cardiomyopathy and worsening heart failure underwent HeartMate 3 implantation with aortic valve repair. On postoperative day 6, chest pain and reduced device flow prompted evaluation; thrombosis of the left coronary cusp had occluded the left main trunk and caused myocardial infarction. Emergency percutaneous coronary intervention was followed by surgical thrombectomy and an outflow graft–aortic root bypass using a saphenous vein graft, intended to reduce aortic-root blood stasis and prevent recurrence. Postoperative computed tomography showed a patent graft without recurrent thrombus, while computational fluid dynamics demonstrated altered aortic-root flow velocity and wall shear stress.
What made this case unusual
The bypass connected the LVAD outflow graft to the aortic root as a strategy to address blood stasis after thrombectomy for cusp thrombosis causing left main occlusion.
Diagnostic / clinical pearl
After LVAD implantation, chest pain and reduced device flow may signal aortic-root thrombosis with coronary obstruction; this case illustrates the need to consider that complication in the postoperative assessment.
Why it matters
Imaging and computational fluid dynamics findings support further study of outflow graft–aortic root bypass for preventing recurrent thrombosis, but its effect on clinical outcomes remains uncertain.