Background
Thrombotic complications have been a major limitation with left
ventricular assist devices since initial designs. With design
modifications magnetically levitated rotor, wide flow gaps, and reduced
heat generation, the updated Heartmate 3 Left ventricular assist device
(Abbott) has been shown to have favourable outcomes(1). Despite these
improvements pump thrombosis remains a devastating potential
complication. With clot formation within the LVAD machinery,
interference in pump function may occur, manifesting as hemolysis,
systemic embolism, and obstruction in pump flow(2). Protocols at the
time of implant as well as systemic anticoagulation with vitamin k
antagonists and antiplatelet therapy reduce risk but events still
occur(3). Confirmation of LVAD thrombosis can be a difficult diagnosis,
requiring multimodality imaging including echocardiography assessing
flow patterns and appropriate ventricular unloading to CT or
conventional angiography evaluating for filling defects. Following
diagnosis therapies may include intensification of anticoagulation,
thrombolysis or device exchange(4). Infrequently, however, when an LVAD
becomes non-functional clinicians may fortuitously discover that their
patient is no longer dependent on mechanical support. Device
deactivation is typically reserved for end-of-life care, typically in
destination therapy patients or those who have suffered devastating
complications(5).
Cardiac recovery in heart failure in the context of the presence of a
left ventricular assist device (LVAD) is not an unknown occurrence(6),
Younger age, female sex, and heart failure due to non-ischemic causes
are known predicators of cardiac recovery(6). When recovery occurs, the
LVAD can either be explanted in their entirety or simply decommissioned
with varying methods.