We experienced two cases of successful surgical correction of HeartMate 3 outflow graft twisting through a subcostal approach. They were diagnosed with computed tomography or pull back pressure measurement. Technically, a subcostal approach allowed us to access directly to the twisted outflow graft and the device connector in a less invasive fashion without a re-sternotomy. Diagnostic modality and surgical tips are presented.

We report the successful endovascular repair of a rare case of aortic rupture caused by axillary intra-aortic balloon pump insertion failure. A 38-year-old Jehovah’s Witness female with situs inversus totalis was referred to our hospital for acute decompensated heart failure. We placed an axillary intra-aortic balloon pump for circulatory support. However, an exchange was required due to balloon malfunction (kinked driveline). Unfortunately, the exchange was complicated by an iatrogenic aortic rupture along with large hematoma compressing the trachea. Emergent endovascular repair was performed successfully without any blood transfusion. Postoperative computed tomography showed a successfully repaired aorta and resolving hematoma.