35. With full antiplatelet and anticoagulant coverage: Still aortic root and left main coronary artery thrombosis can occur early post left ventricular assist device implantation

We describe a case of 39 years old male underwent continuous flow LVAD implantation (HeartWare) HVAD as destination therapy (DT) for severe left ventricular dysfunction ,moderate right ventricular dysfunction and severe pulmonary hypertension , presented 3rd day post-operatively with polymorphic ventricular tachycardia (VT storm) alternating with VF then aborted to bradycardia with complete heart block .Coronary angiography revealed big LM coronary artery thrombus extended distally to mid LCX and mid LAD arteries and pedunculating into the aortic root proximally inspite of full coverage with antiplatelet and anticoagulant therapy. To our knowledge this is the 1st case documented with this early presentation post (HeartWare) HVAD device implantation as destination therapy (DT).We describe a case of 39 years old male underwent continuous flow LVAD implantation (HeartWare) HVAD as destination therapy (DT) for severe left ventricular dysfunction, moderate right ventricular dysfunction and severe pulmonary hypertension , presented 3rd day post-operatively with polymorphic ventricular tachycardia (VT storm) alternating with VF then aborted to bradycardia with complete heart block . Coronary angiography revealed big LM coronary artery thrombus extended distally to mid LCX and mid LAD arteries and pedunculating into the aortic root proximally inspite of full coverage with antiplatelet and anticoagulant therapy. To our knowledge this is the 1st case documented with this early presentation post (HeartWare) HVAD device implantation as destination therapy (DT). In the modern era, the use of surgically implanted left ventricular assist devices (LVADs) as a bridge therapy to either recovery or cardiac transplantation has given a hope at the end of the HF tunnel. More recently, the use of LVADs as ‘destination therapy (DT)’ has further illuminated a future for patients with end-stage HF. To our knowledge this is the 1st case documented with this early presentation post (HeartWare)HVAD device implantation as destination therapy (DT)