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Abstract
Background: External outflow graft obstruction (EOGO) is an emerging complication due to improved pump durability. We experienced a rare sequence of complications, inflow thrombus formation following EOGO with reduced left-ventricular assist device flow.
Case Summary: A 41-year-old man, 2 years post HeartMate 3 (HM3) implantation, presented with low-flow from EOGO. Outflow graft stenting resulted in improvement but returned 1 month later with persistent low flow. Pump thrombosis was excluded. Flow had minimal response to RPM increase. Outflow graft was widely patent. Inflow obstruction was suspected, and HM3-to-HM3 exchange revealed extensive thrombus formation within the inflow cannula. Left-ventricular assist device flow returned to normal. Postoperative recovery was uneventful.
Discussion: The cause of this inflow thrombus formation, an extremely rare complication, was suspected to be from EOGO low flow.
Take-Home Messages: Inflow thrombosis should be included in the differential diagnosis with low flow. EOGO low flow could cause secondary inflow thrombosis.
Document Type
Article
Publication Date
2026
Digital Object Identifier (DOI)
https://doi.org/10.1016/j.jaccas.2025.106402
Repository Citation
Malik, Mohammad J.; Chung, Jin Woo; Loebe, Matthias; Gurley, John C.; Birks, Emma J.; Kothari, Dhruv; and Kawabori, Masashi, "Durable Left-Ventricular Assist Device Inflow Thrombosis Following External Outflow Graft Obstruction" (2026). Surgery Faculty Publications. 56.
https://uknowledge.uky.edu/surgery_facpub/56
Notes/Citation Information
© 2026 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).