Early Aortic Root and Left Main Coronary Artery Thrombosis after Left Ventricular Assist Device Implantation

Introduction:

In the modern era, the use of surgically implanted left ventricular assist devices (LVADs) as a bridge therapy to either recovery or cardiac transplantation has given a hope at the end of the HF course of disease. More recently, the use of LVADs as “DT” has further illuminated a future for patients with end-stage HF.

Today, LVADs have evolved from large, bulky pulsatile systems to smaller, compact, fully implantable continuous flow (CF) pumps. These CF-LVADs use rotodynamic pumps to transfer kinetic energy from a circulating impeller to the bloodstream, thereby generating forward flow .

Starling et al. summarized the rate of device thrombosis among 837 patients across three implantation centers in USA, and Kirklin et al. described data reported to the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) on the rate of device thrombosis among 6910 patients from 2011 till April 2014. But all these big studies were done on Heart Mate2 devices (Thoratec) and very few were done on (HeartWare) HVAD devices.

Left main coronary artery thrombosis and aortic root thrombosis are rarely described, but in our case; thrombus had occurred earlywith the newer generation (HeartWare) HVAD device despite full anticoagulation and antithrombotic coverage.

Case Report:

39 years old man was diagnosed with severe dilated cardiomyopathy since 2003 with recurrent admissions due to decompensated congestive heart failure. Dual Chamber ICD was inserted in 2012, but removed after few months due to infection and thrombosis. He is a known diabetic on insulin therapy, heavy smoker with liver cardiac cirrhosis and has severe chronic kidney disease with baseline creatinine around 200 mmol/L. Echocardiography showed severe LV dysfunction with EF less than 20% and RV moderate to severe dysfunction with systolic PAP pressure 55-65 mmHg.