Late Inflow Or Outflow Obstruction Requiring Surgical Intervention After Heartmate 3 Left Ventricular Assist Device Insertion

Inflow or outflow obstruction is a rare, but critical complication after HeartMate 3 left ventricular assist device implantation. We retrospectively reviewed 166 patients who underwent primary HeartMate 3 implantation at our centre between November 2014 and July 2019. Three cases of inflow obstruction and 3 cases of outflow obstruction were identified. Presence of low flow alarm was the most common presenting sign and they were free from heart failure symptoms except in 1 case. They all underwent surgical correction and the median time from primary implantation to reintervention was 406.5 days. Computed tomography angiogram identified a problem in 5 out of 6 cases. Clinical symptoms and/or alarms resolved after surgery, but 1 case developed recurrent low flow alarm due to partial occlusion of inflow by fibrous tissue who eventually underwent heart transplant. All patients remain alive with median follow-up of 433.5 days. Prompt surgical intervention in late inflow and outflow obstruction after HeartMate 3 implantation resulted in favourable outcomes.