Conclusions
This case is unique in that cardiac recovery was a serendipitous
discovery following pump thrombosis. At the time of identification, the
LVAD pump was entirely non-functional with inflow and outflows
thrombosed. Surgical explant would be associated with significant risk
(particularly bleeding given prior history) with uncertain benefit. The
decision was made to leave LVAD in situ, decommissioning, with ongoing
medical heart failure management. The short inflow cannula of the
Heartmate 3 though measuring only 20mm protruding into the LV cavity at
the apex, was felt to remain a thrombotic risk and systemic
anticoagulation was continued. With time, endothelialisation will occur
with lower risks of systemic embolization and the anticoagulation
strategy will be revisited.