# Biventricular unloading and rhythm control leading to biventricular recovery: a case report

## TL;DR

A 35-year-old man with severe heart failure was successfully treated with mechanical support and recovered enough to leave the hospital.

## Contribution

This case report highlights the role of biventricular unloading and medical therapy in achieving myocardial recovery in cardiogenic shock.

## Key findings

- Biventricular assist devices enabled substantial myocardial recovery after five months of support.
- Optimized medical therapy and ventricular unloading improved cardiac function enough for weaning from mechanical circulatory support.
- The case demonstrates that MCS can serve as a platform for neurohormonal optimization and recovery assessment.

## Abstract

Temporary mechanical circulatory support (tMCS) is a life-saving intervention in cardiogenic shock (CS), though not without risks. Increasing attention has been given to ventricular unloading and its role in myocardial recovery, particularly in reversible cardiomyopathies.

A 35-year-old man presenting with CS was initially treated with veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and Impella (ECPELLA). Due to complications, support was escalated to Levitronix biventricular assist device. After 5 months of support and optimized medical therapy, substantial myocardial recovery enabled weaning from MCS and successful hospital discharge.

MCS provides critical time to investigate the underlying cause of CS and assess the potential for recovery. This case illustrates how MCS can be both life-saving and a platform for ventricular unloading and neurohormonal optimization. Although full recovery is rare in severe cases, such strategies may improve cardiac function and enable successful weaning from support.