Successful heart transplantation following long-term left ventricular assist device support in a patient with peripartum cardiomyopathy: The first case in Serbia

Introduction. Peripartum cardiomyopathy (PPCM) is a rare and potentially life-threatening cause of heart failure occurring during late pregnancy or the early postpartum period. While medical therapy remains the first-line treatment, refractory or end-stage heart failure may necessitate surgical intervention, including mechanical circulatory support or heart transplantation. Case outline. We report the first case in Serbia of a young woman with PPCM who successfully underwent left ventricular assist device (LVAD) implantation followed by orthotopic heart transplantation. A 25-year-old woman presented with severe biventricular heart failure 3.5 months postpartum. Despite optimal medical management, her condition deteriorated, necessitating LVAD implantation as bridgeto- transplant therapy. She remained on LVAD support for five years, achieving excellent quality of life, until a suitable donor heart became available. Heart transplantation was performed using the bicaval technique, with no perioperative complications or early graft rejection. The patient was discharged in stable condition. Conclusion. This case highlights the feasibility and success of a multidisciplinary approach combining LVAD support and heart transplantation in managing advanced PPCM. Timely recognition of disease progression and individualized surgical planning are critical to achieving favorable outcomes in this high-risk population.