Patient with history of non-ischemic cardiomyopathy and systolic heart failure who was treated with left ventricular assist device (lvad) (heartware hvad) implantation and aortic valve replacement early 2019.Towards the end of 2021, patient developed signs of pump thrombosis (increasing power reports, dark urine, elevated plasma free hemoglobin and lactate dehydrogenase) necessitating consideration for pump replacement.The two choices for care were to proceed with high risk pump replacement or to choose palliative care/hospice.Patient proceeded with pump replacement.Medtronic hvad was replaced with an abbott heartmate 3 (hvads are no longer manufactured) and developed significant bleeding requiring transfusion of multiple blood products, right heart failure requiring temporary mechanical support with an impella p7, a return to the or for bleeding/washout and high vasopressor requirements.Patient went on to develop multi-organ dysfunction and bacteremia.Goals of care discussions with family led to decision to withdraw life-prolonging interventions and he died early 2022.The hvad was returned to medtronic for analysis following pump exchange.In april 2022 we were notified by medtronic that they had received 3 complaints of patients with suspicion of pump thrombosis and had identified a device malfunction upon inspection of the 3 returned pumps.Wear marks indicated that the impeller was rotating non-concentrically and contacting the center post of the pump.The investigation suggested this was caused by a weld defect that allowed moisture into the center post and corroded the magnets.
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