Incidence and clinical implications of aortic root thrombosis in LVAD patients: A single-center experience

Background: Aortic root thrombosis (ART) in left ventricular assist device (LVAD) patients has gained attention due to potential clinical consequences. This study aims to assess the clinical outcomes associated with ART in LVAD patients. Methods: We retrospectively evaluated adult patients who received LVAD implants at our center between January 2020 and March 2022. Pre-operative data, including demographics, laboratory values, and echocardiographic assessments, were similar between the ART and non-ART groups. Composite outcomes such as cerebrovascular events, pump thrombosis, myocardial infarction, embolic events, bleeding, right ventricular (RV) failure, and mortality post-discharge were examined. Results: The study included 44 outpatients (36 HeartMate 3, 8 HeartWare). ART was identified in 20 patients (45%) post-discharge. The "no ART" group had a mean age of 47±10 years (23 of 24 patients were male, 95.8%), while the "ART" group had a mean age of 48±12 years (15 of 20 patients were male, 75%), with no significant age difference (p>0.05). Thrombosis occurred at a median of 59 days post-implantation, primarily affecting the non-coronary cusp in 50% of the ART group. The median follow-up period was 416 days. No significant differences were found in composite outcomes (p=0.276), mortality (p=0.814), bleeding (p=0.808), or RV failure (p=0.197). Conclusion: ART may be under-recognized in LVAD patients, potentially leading to cardiac and end-organ damage. While ART does not significantly impact mortality, it emphasizes the need for careful management of LVAD patients.