<h3>Purpose</h3> Left atrial appendage occlusion (LAAO) at time of implantation was previously shown to reduce thromboembolic events (TEs) in continuous flow left ventricular assist devices (LVADs); however, the efficacy of LAAO in HM3 recipients is unknown. This study aims to assess the clinical impact of LAAO in HM 3 patients. <h3>Methods</h3> Adults receiving first HM3 implantation from November 2014 through December 2019 at our center were retrospectively reviewed. TEs included device thrombosis and ischemic strokes. Patients were classified by whether they received LAAO or not. Incidence of TEs was compared between groups using cumulative incidence curves with competing risks (death and heart transplant) and risk factors for TEs were assessed with Fine and Gray competing risk regression. <h3>Results</h3> 182 patients received HM 3s during the study period. Ninety-nine HM3 patients (54%) received LAAO versus 83 (46%) who did not. Zero LAAO patients (0%) had prior coronary artery bypass grafting, compared to 35 patients (42%) who did not receive LAAO (p < 0.001). Forty-six LAAO patients (48%) had a past medical history of atrial fibrillation, which was similar to the 45 patients (55%) who did not receive LAAO (p = 0.48). There were 14 thromboembolic events, including 13 strokes (7%) and one pump thrombosis (0.5%). Cumulative incidence of TEs was similar in both groups (less than 10% at three years). LAAO was not associated with TEs (p = 0.35) in Fine and Gray competing risk regression and no statistically significant risk factors for TEs were identified. <h3>Conclusion</h3> A low number of TEs was observed in HM3 recipients. LAAO did not further reduce the rate of TEs in this patient population.