Partial outflow pump dehiscence following off-pump HeartWare left ventricular assist device implantation in a patient with the Marfan syndrome.

A 30-year-old man with Marfan syndrome, biventricular heart failure, and an earlier left ventricular assist device placement presented to the emergency department with chest discomfort. Computed tomography with contrast showed contrast extravasation from the anterior aspect of the ascending aorta. The patient was immediately taken to the operating room, where re-exploration of the mediastinum disclosed two needle holes from the distal anastomosis at the toe of the graft that were no longer hemostatic, and it appeared that the patient's heart had dilated in the interim to the point that the outflow graft was too snug. In the operating room, it appeared that a markedly dilated right ventricle was stretching the graft. The patient underwent lengthening of the left ventricular outflow graft and fully recovered.