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.