Left ventricular assist devices can extend life for select patients with advanced heart failure. However, adverse events, including outflow graft obstruction, may occur over time. Outflow graft obstruction is generally insidious in onset and may result in low LVAD flows and symptoms of heart failure. In this report, we describe a patient who presented with acute decompensation requiring temporary mechanical support due to development of extrinsic compression of the outflow graft after HeartMate 3 implantation. The acuity and severity of this case demonstrate the importance of avoiding this complication and promptly diagnosing and treating it if it does occur.