Successful Prevention of Aortic Root Thrombosis Following Left Ventricular Assist Device Implantation Using Outflow Graft–Aortic Root Bypass

Aortic root thrombosis is a rare but potentially fatal complication associated with left ventricular assist device usage, potentially causing myocardial infarction and right heart failure. A patient with aortic root thrombosis causing left main trunk occlusion early following HeartMate 3 implantation was successfully treated with surgical thrombectomy and a novel outflow graft-aortic root bypass. A 59 year old man with dilated cardiomyopathy and deteriorating heart failure underwent HeartMate 3 implantation and aortic valve repair for advanced circulatory support. Chest pain and reduced left ventricular assist device flow were noted on postoperative day 6. Left coronary cusp thrombosis occluded the left main trunk, causing myocardial infarction. Following emergency percutaneous coronary intervention, surgical thrombectomy was performed, accompanied by an outflow graft-aortic root bypass using a saphenous vein graft to relieve blood stasis in the aortic root for recurrence prevention. Postoperative computed tomography indicated graft patency and no thrombus recurrence. Computational fluid dynamics analysis showed altered flow velocity and wall shear stress within the aortic root, suggesting thrombosis prevention by the bypass. This case highlights a potential role of outflow graft-aortic bypass for recurrent aortic root thrombosis prevention. Additional studies are required to assess effects on clinical outcomes.