Microaxial Flow Pump Thrombosis Presenting as Predominant Direct Hyperbilirubinemia.

Sahiljeet Singh, Suguru Ohira, Dina Al-Rameni, Abhishek Jaiswal

Abstract readCase Reports

In one paragraph

Article in JACC. Case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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4 authors.

Sahiljeet SinghDepartment of Hospital Medicine, Hartford Hospital, Hartford, Connecticut, USA.

Suguru OhiraDivision of Cardiac Surgery, Hartford HealthCare Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut, USA.

Dina Al-RameniDivision of Cardiac Surgery, Hartford HealthCare Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut, USA.

Abhishek JaiswalDivision of Advanced Heart Failure and Transplant, Hartford HealthCare Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut, USA. Electronic address: jais.abhishek@gmail.com.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundClinically significant hemolysis and device thrombosis are uncommon with the Impella 5.5, and presentation with predominant direct hyperbilirubinemia has not been described. CASE SUMMARY: A 57-year-old man with refractory cardiogenic shock underwent Impella 5.5 placement as a bridge to transplant. He developed severe direct-predominant hyperbilirubinemia (total bilirubin 18.4 mg/dL; direct 11.7 mg/dL) with rising lactate dehydrogenase (1,395 U/L) and undetectable haptoglobin, despite normal purge pressures and no device alarms. Duplex ultrasonography excluded biliary obstruction. Device exchange revealed a large, organized thrombus in the motor/outflow housing, after which hemolysis was resolved, and biochemical improvement followed, allowing successful bridging to heart transplantation. DISCUSSION: Occult Impella thrombosis may present as direct-predominant hyperbilirubinemia, an atypical pattern that can mimic hepatobiliary disease and confound the diagnostic evaluation. TAKE-HOME MESSAGES: Direct hyperbilirubinemia during Impella support should prompt evaluation for subclinical device thrombosis. Timely device exchange can reverse hemolysis and preserve transplant candidacy.

Indexed as

cardiogenic shockdirect hyperbilirubinemiaheart transplanthemolysisImpella 5.5microaxial flow pumppercutaneous ventricular assist devicepump thrombosis

Identifiers

PMID42554555

DOI10.1016/j.jaccas.2026.109652

PMCPMC13689768

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