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

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 guideline-directed 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.