Vanishing Aortic Valve Cusp: A Rare Case of Aortic Valve Insufficiency in a Durable Left Ventricular Assist Device Recipient After Micro-Axial Flow Pump Support

De novo aortic insufficiency (AI) is a recognized complication in patients supported with continuous-flow durable left ventricular assist devices (LVADs), carrying important clinical consequences including heart failure progression and increased device-related morbidity. We report the case of a HeartMate 3 (Abbott Inc., Chicago, Illinois, USA) patient, previously supported with a micro-axial flow pump (mAFP), who developed severe AI within the first year of LVAD support and ultimately underwent urgent heart transplantation. Intraoperative inspection and histopathological analysis revealed mechanical injury of the aortic valve, likely initiated during mAFP implantation and subsequently exacerbated by LVAD-related turbulent flow. These findings suggest that even subtle valve trauma may evolve into clinically significant AI under continuous-flow support. This case underscores the need for a proactive strategy to minimize the risk of aortic valve micro-lesions during mAFP placement, including meticulous preprocedural assessment of aortic root and valve anatomy and careful intraprocedural technique.