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Ann Thorac Surg 2003;78:689-691
© 2003 The Society of Thoracic Surgeons

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Case report

Late bleeding from right internal mammary artery after heartmate left ventricular assist device implantation

^a Division of Cardiothoracic Surgery, Columbia University, College of Physicians and Surgeons, New York, New York, USA

Accepted for publication June 23, 2003.

^* Address reprint requests to Dr Naka, Division of Cardiothoracic Surgery, Columbia University, College of Physicians and Surgeons, Milstein 7-435, 177 Fort Washington Ave, New York, NY 10032, USA
e-mail: yn33{at}columbia.edu

Postoperative bleeding is one of the major complications after implantation of left ventricular assist devices. We experienced 5 unusual cases, which had bleeding from the right internal mammary artery between 5 and 69 days after implantation of a Heartmate (Thoratec Corporation, Pleasanton, CA) device. It was evident that the outflow graft had eroded through the vessel. Sudden decreases in device flow, hypotension, bleeding from the driveline or chest tube sites, and a drop in hematocrit were the initial manifestations. Chest roentgenogram and transthoracic echocardiography were effective in identifying hemothorax and cardiac tamponade. Four out of 5 patients survived to heart transplantation and were discharged from the hospital. When identified and treated appropriately, this complication does not impair patient outcome.

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