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

BACKGROUND

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.

CASE SUMMARY: 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.

DISCUSSION: 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.