Abstract
Background: Left ventricular assist devices have been a
significant development in the treatment of patients with advanced heart
failure supporting circulation as a bridge to transplant, recovery or
long-term destination therapy. When ventricular recovery occurs, there
are multiple described ways of proceeding. HM2 decommissions are well
described with varying degrees of explant operations, less so in HM3 due
to the novelty of the device. In certain situations, invasive surgery
can carry high risk and so a minimally invasive decommission, leaving
the LVAD essentially intact in situ can be considered. Case
report In this report, we describe the case of a 35-year-old male
diagnosed with an idiopathic dilated cardiomyopathy requiring an LVAD
with subsequent identification of cardiac recovery with the asymptomatic
thrombosis of the 2 nd HM3 device. Investigations
demonstrated absent flow through the pump whilst the patient-reported
NYHA I functional class symptoms. The Driveline was cut with the
remaining internal pump components decommissioned and left in situ. At 1
year the patient continues to do well with continued features of cardiac
recovery with an LVEF of over 40%. Conclusion LV recovery is
well recognized with typical management being LVAD explant surgeries
performed. Each case should be analyzed for risks and benefits to the
patient and future research showed be directed towards levels of
decommissioning surgery and management post-LVAD decommission patient
care.