Surgical intervention for left ventricular assist device outflow graft obstruction due to external compression.

Left ventricular assist device outflow graft obstruction is an uncommon but serious complication. The causes of left ventricular assist device outflow graft obstruction include thrombus, outflow graft kink or torsion and external compression. The HeartMate 3 left ventricular assist device was reported to have a low risk of thromboembolic events. However, the deposition of bio-debris between the semi-permeable left ventricular assist device outflow graft and the impermeable bend relief has been increasingly recognized as a cause of external compression. The potential treatment options include percutaneous insertion of a stent, surgical removal of the bio-debris, change of left ventricular assist device, and an urgent heart transplant. We report a case of left ventricular assist device outflow graft compression successfully treated by removal of the bio-debris via a subxiphoid approach.