What question did this study set out to answer?

To describe successful left ventricular assist device (LVAD) weaning and surgical discontinuation following reverse myocardial remodeling in advanced non-ischemic cardiomyopathy.

January 17, 2026Srce i krvni sudoviOpen Access

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

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Key result

LVAD support may enable myocardial recovery and successful explantation without transplant in selected NICM patients.

Why the study?

The bridge to recovery strategy allowing LVAD explantation after reverse structural remodeling and myocardial recovery remains underutilized.

Key Points

To describe successful left ventricular assist device (LVAD) weaning and surgical discontinuation following reverse myocardial remodeling in advanced non-ischemic cardiomyopathy.
Monitored a 52-year-old male with acute refractory heart failure secondary to myocarditis who received a HeartMate II LVAD as a bridge to transplant.
Optimized guideline-directed medical therapy including ACE inhibitors, beta-blockers, and mineralocorticoid receptor antagonists, accompanied by serial echocardiography and ramp speed testing over 3 years.
Conducted a turn-down hemodynamic assay under zero-flow conditions prior to surgical outflow graft closure via right minithoracotomy with the pump retained in situ.
Mechanical unloading and neurohumoral blockade induced cardiac reverse remodeling, improving left ventricular ejection fraction from 23% pre-implant to >40% during ramp testing.
Device deactivation resolved secondary ventricular arrhythmias and chronic Staphylococcus aureus driveline infection while avoiding full median sternotomy.
At 5-year follow-up post-explantation, the patient remained clinically stable on guideline-directed medical therapy with preserved left ventricular systolic function.

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.

Implication

Supports LVAD explantation consideration in select non-ischemic cases; hypothesis-generating and requires prospective validation before practice change.

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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Cite This Study

Ugovšek et al. (2025) studied this question. LVAD support in selected patients with non-ischemic cardiomyopathy may enable myocardial recovery and successful device explantation, providing an alternative to transplantation.

synapsesocial.com/papers/696b25cfd2a12237a9349209 https://doi.org/10.5937/siks2502031u

Topics

Mechanical circulatory support

Heart transplantation

HFrEF treatment

Cardiomyopathy

Heart failure

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Implication

Supports LVAD explantation consideration in select non-ischemic cases; hypothesis-generating and requires prospective validation before practice change.

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

Key Points

Structured PICO

Implication

Abstract

Discussion

Cite This Study

Topics

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

Key Points

Structured PICO

Implication

Abstract

Discussion

Cite This Study

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Topics

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