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.