From Normal to Zero Flow in 30 Seconds on HeartMate 3 LVAD: What Happened?

Background: We present a patient who acutely developed a zero flow alarm without warning signs almost 4 months after a HeartMate 3 (HM3) left ventricular assist device (LVAD) implantation. Case Summary: Patient was doing well as an outpatient when suddenly the zero flow alarm of his HM3 sounded without change in pump parameters. Patient progressed to cardiac arrest and did not survive. Autopsy concluded that his death was secondary to chronic heart failure, but industry analysis of the LVAD revealed impeller clot ingestion. Discussion: Given the low incidence of pump thrombosis published with HM3, we present this case of ingested thrombus occurring without warning signs. Other LVAD parameters were normal at the time of the incident, despite the zero flow. Take-Home Message: In an era when HM3 is the only durable LVAD available for de novo implant in the United States, we, as a community, need to better understand the true incidence of this complication and potential management options.