The other had chronic myocarditis with dilated myopathy and mild interstitial fibrosis. One of them was diagnosed with acute viral myocarditis. Two patients were weaned and successfully removed from the VAD. The final decision on explantation was based on at least three pump stops. Finally, pump stops of up to 30 min were performed once a week (phase C). A daily temporary reduction in pump rate (phase A) was followed by a permanent reduction in rate (phase B). Echocardiographic examination included both conventional real-time 3D echocardiography (RT3DE) and speckle tracking (ST). They were monitored regularly using clinical information and functional imaging with VAD support. An exercise training protocol was used in 3 patients (8 months, 18 months and 8 years old) with histological CM findings and myocarditis. Testing the load-bearing capacity of the supported left ventricle (LV) by temporarily and gradually reducing mechanical support during cardiac exercise can help identify responders and potentially aid the recovery process. The identification of these patients is of great importance as recovery may be missed if the heart is unloaded by the ventricular assist device (VAD).
A few patients can be weaned from support devices if recovery can be achieved. Patients with refractory heart failure due to chronic progressive cardiac myopathy (CM) may require mechanical circulatory support as a bridge to transplantation.
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