Abstract 14358: A Rare Case of Refractory Ventricular Arrhythmias Caused by Subacute Aortic Root Thrombosis Following Left Ventricular Assist Device

Introduction: Aortic Root thrombus (ART) is relatively uncommon complication following left ventricular assist device (LVAD) therapy with significant morbidity and mortality. Case: A 51-year-old male with coronary artery disease with CABG (LIMA to LAD and sequential SVG) presented with acute cardiogenic shock. EKG showed right bundle branch block with diffuse T wave inversions. Coronary angiogram showed severe three vessel disease with occlusion of all vein grafts except LIMA-LAD. Patient subsequently underwent LVAD with HM3 implant placement as a destination therapy. He was started on warfarin with heparin drip as a bridge. Post op course was complicated by recurrent VF storm. Patient was started on amiodarone and lidocaine. A transthoracic echocardiogram showed LVAD inflow cannula in place and aortic valve was noted to be closed with every beat. HM3 speed was decreased to 5500 rpm. Patient continued to have recurrent episodes of VF, refractory to cardioversion and anti-arrhythmic agents. CT angiogram showed aortic root filling defect consistent with thrombosis extending from the leaflets towards the Sino tubular junction, along the left coronary cusp leaflets. Patient eventually required VT ablation for refractory ventricular arrhythmia. Patient underwent median sternotomy for surgical removal of aortic root thrombus which showed parts of the thrombus intimately connected to the aortic root wall including the left main and right coronary ostia. Post op patient was continued on systematic anticoagulation with noted clinical improvement. Conclusion: ART after LVAD placement is a rare complication and can be associated with myocardial infarction and thromboembolic events. It can compromise coronary perfusion and result in ischemic ventricular arrhythmias as seen in our case. Management includes surgical removal of the pump or orthoptic heart transplantation. VT ablation should be considered if no ischemic culprit identified