Introduction
Left ventricular assist devices (LVADs) have become integral to the treatment of advanced heart failure. Surgical bleeding is a common complication of LVAD implantation, with rates reported as high as 60%; the majority of cases require surgical intervention.1,2 The intrapericardial design of centripetal flow LVADs may reduce the risk of surgical bleeding by obviating the need for a preperitoneal or intraperitoneal pocket to house the pump. However, recent studies have shown no convincing evidence of this.2,3 Here we describe an unusual source of surgical bleeding after intrapericardial LVAD placement caused by erosion into an intercostal artery.