A 47-year-old female with a history of peripartum cardiomyopathy and HeartMate-II LVAD (Thoratec Corporation, Pleasanton, CA, USA) implantation presented with a broken driveline associated with foul smelling discharge. The LVAD was implanted three years ago at an outside institution and her pre-implant psychosocial evaluation revealed stable mood, normal cognition, and appropriate family support. She had a chronic driveline infection and eighteen months after implantation she suffered an ischemic stroke. She experienced psychosocial problems: mild depression, financial stressors, and divorce. She progressively became non-compliant with her medications (lisinopril, metoprolol, aspirin, and warfarin) and follow-up. She had cut the driveline two weeks prior to presentation to our center as she was “fed up with it and no longer needed it” (Fig. 1A). On examination she had Broca’s aphasia and rightsided hemiparesis consistent with her prior left middle cerebral artery stroke. Brain CT showed old infarcts and encephalomalacia (Fig. 1B). Transesophageal echocardiography revealed absence of flow in the LVAD conduit (Fig. 1C). Psychosocial and psychiatric evaluation revealed post-stroke labile mood with personality changes, bipolar disorder, and psychotic traits on Aid to Capacity Evaluation. She had euphoric mood and tangential speech with a disorganized thought process. Cognition was impaired with a Mini Mental State Exam score of 19/30 and a Montreal Cognitive Assessment Score of 19/30. She responded favorably to risperidone but poor insight persisted. A multidisciplinary team recommended explant of the nonfunctioning LVAD, which she refused. Therefore, she was Amit Badiye1, Jerson Munoz-Mendoza2, Sandra V. Chaparro1