Case report : decommissioning of a left ventricular assist device following reverse remodeling in non-ischemic cardiomyopathy patient

Ugovšek, Sabina (author), Zemljič, Gregor (author), Cerar, Andraž (author), Frljak, Sabina (author), Okrajšek, Renata (author), Šebeštjen, Miran (author), Kneževič, Ivan (author), Dolenc-Stražar, Zvezdana (author), Poglajen, Gregor (author)

Background Left ventricular assist devices (LVAD) improves clinical outcomes in patients with advanced heart failure (HF) and may induce myocardial recovery. LVAD explantation remains underutilized due to challenges in identifying patients with true recovery potential. We describe a case of a patient with advanced HF due to myocarditis, who underwent LVAD implantation and after reverse structural remodelling facilitated by a structural recovery protocol, LVAD weaning was possible. Case presentation A patient presented with an advanced HF due to myocarditis. Despite receiving guidelinedirected medical therapy (GDMT) and levosimendan, left ventricular function failed to improve and the patient remained inotrope dependent. The patient was approved and listed for heart transplant. Due to progressive worsening despite inotropic support, the patient underwent LVAD HeartMate II implantation. Through optimized mechanical unloading, GDMT, and structured follow-up, echocardiography demonstrated progressive cardiac reverse remodelling and LVAD decommissioning was feasible. Conclusion Despite low explantation and decommissioning rates in registries, dedicated recovery programs demonstrate that through combining mechanical unloading and GDMT optimization, sustained recovery and LVAD weaning are possible. This strategy offers a valuable alternative to transplantation and highlights the importance of standardized protocols in identifying and managing recovery candidates.

• Language: English
• Keywords: case report, guideline directed medical therapy, heart failure, LVAD decommissioning, myocardial recovery
• Work type: Article
• Typology: 1.03 - Other scientific articles
• Organization: MF - Faculty of Medicine
• Publication status: Published
• Publication version: Version of Record
• Year: 2026
• Number of pages: 775
• Numbering: Vol. 21, iss. 1 , art. 775
• PID: 20.500.12556/RUL-190599
• UDC: 616.1-089
• ISSN on article: 1749-8090
• DOI: 10.1186/s13019-026-04609-5
• COBISS.SI-ID: 287894531
• Publication date in RUL: 30.10.2026

Record is a part of a journal

• Title: Journal of cardiothoracic surgery
• Publisher: Springer Nature
• ISSN: 1749-8090
• COBISS.SI-ID: 3053332

Licences

• License: CC BY-NC-ND 4.0, Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
• Link: http://creativecommons.org/licenses/by-nc-nd/4.0/
• Description: The most restrictive Creative Commons license. This only allows people to download and share the work for no commercial gain and for no other purposes.

Secondary language

• Language: Slovenian
• Keywords: ptikaz primera, s smernicami podprto zdravljenje z zdravili, srčno popuščanje, izključitev mehanične podpore levega prekata, izključitev LVAD, okrevanje miokarda, izboljšanje delovanja srčne mišice

Projects

• Funder: ARIS - Slovenian Research and Innovation Agency
• Project number: P3-0457
• Name: Nove strategije diagnostike in zdravljenja srčnega popuščanja