What question did this study set out to answer?

To explore the potential for myocardial recovery and LVAD explantation in patients with non-ischemic cardiomyopathy.

January 17, 2026Open Access

Explantation of a left ventricular assist device following reverse remodeling in non-ischemic cardiomyopathy

SUSabina UgovšekUniversity of Ljubljana IKIvan KneževićLjubljana University Medical Centre GPGregor PoglajenHeart Failure & Transplant

Key Result

LVAD support in selected patients with non-ischemic cardiomyopathy may enable myocardial recovery and successful device explantation, providing an alternative to transplantation.

Key Points

To explore the potential for myocardial recovery and LVAD explantation in patients with non-ischemic cardiomyopathy.
Demonstrated a case of LVAD support leading to reverse remodeling.
Evaluated patient selection based on heart failure etiology and organ dysfunction.
Discussed the importance of standardized protocols for patient management.
The case showed significant myocardial recovery after LVAD support.
Suggests that LVAD explantation is a feasible alternative to heart transplantation for select patients.

Structured PICO

Population

1 patient, 52-year-old male with advanced heart failure due to myocarditis, severely reduced ejection fraction of 23%, moderate diastolic dysfunction, severe functional mitral regurgitation, and inotrope-dependence.

Intervention

Left ventricular assist device (LVAD HeartMate II) implantation followed by decommissioning (pump left in situ, driveline cut, outflow graft surgically closed) after 3 years of support and reverse remodeling.

Outcome

Clinical stability and preserved LV systolic function at 5-year follow-up.

LVAD decommissioning is a viable strategy for selected patients with non-ischemic cardiomyopathy who experience significant reverse remodeling, offering an alternative to heart transplantation.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Left ventricular assist devices (LVAD) improve clinical outcomes in patients with advanced heart failure (HF), including those with acute refractory HF. In carefully selected patients, depending on HF etiology, duration of HF, and degree of end-organ dysfunction, LVAD support may induce profound reverse structural remodeling and even functional myocardial recovery, ultimately permitting LVAD explantation. This “bridge to recovery” strategy, although conceptually appealing and clinically transformative, remains underutilized. Here, we present a case demonstrating that this strategy offers a valuable alternative to transplantation and highlights the importance of standardized protocols in identifying and managing LVAD recovery candidates.

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