Twists in the outflow graft of the HeartMateTM 3 device (Abbott) have recently been described as a sporadic, late complication. We present a case with a unique combination of external compression of the HeartMate 3 outflow graft by a surgical scar compounded by thrombus formation in the space between the band relief and the outflow graft with associated twist of the outflow graft and severe flow limitation. Computed tomography angiogram (CTA) of the chest was suggestive of outflow graft thrombosis. Our case sheds additional light on the limited specificity of gated CTA in distinguishing the outflow graft twisting from thrombotic obstruction and kinking
