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Left ventricular assist devices (LVAD) are used to support advanced heart failure patients who have failed optimal medical management, meet LVAD criteria, and are deemed to be appropriate surgical candidates. LVAD patients are further advised on symptoms that should prompt notification to the implanting center and are encouraged to contact their LVAD team with device questions and concerns due to morbidity risks unique to this patient population. Mechanical disruption of internal LVAD components is rare and typically requires hospitalization and potentially surgical intervention. External trauma to the LVAD resulting in driveline fracture, torn LVAD outflow grafts, pump displacement, and a kinked inlet cannula have been described. 1 Because these occurrences are rare and often unexpected, identification of the root cause may not always be readily apparent. We describe a previously unreported presentation of a patient supported with an LVAD for more than 4 years who was found to have a broken and dislodged LVAD outflow cuff floating in an abdominal hematoma without pump failure., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Psychosocial factors impact survival in patients undergoing cardiac transplantation, but it is unclear whether they affect outcomes in patients undergoing left ventricular assist device (LVAD) implantation as destination therapy (DT)., Methods: Patients undergoing DT LVAD at the Mayo Clinic in Rochester, MN, from February 2007 to December 2013 were included. Psychosocial characteristics at the time of LVAD implantation were abstracted from the medical record. Andersen-Gill and Cox models were used to examine the association between psychosocial characteristics and all-cause readmission and death, respectively. Patients were censored at death or last follow-up through September 2014., Results: Among 136 patients (mean age. 64 years; 17% female), most were married/living with a partner (82%), half (55%) had post-high school education, and a history of depression was common (32%). Although most patients were former tobacco users (60%) only a small proportion were current tobacco users (10%) and had a history of alcohol abuse (16%) or illegal drug use (7%). After a mean follow-up of 2.2 ± 1.8 years, 78% of patients had been readmitted (range, 0-14 per person) and 49% had died. There were no statistically significant differences in the risk of death according to psychosocial characteristics. However, current tobacco users had lower risk of readmission (adjusted HR, 0.57; 95% CI, 0.38-0.88), while illegal drug use (HR, 1.55; 95% CI, 1.01-2.35) and depression (HR, 1.77; 95% CI, 1.40-2.22) were associated with higher readmission risk., Conclusions: Psychosocial characteristics are not significant predictors of death but are associated with readmission risk after DT LVAD., (Copyright © 2015 Elsevier Inc. All rights reserved.)