Case report: failed restoration of left ventricular function after myosplint® placement followed by successful HeartMate 3™ LVAD implantation

Abstract Background Mechanical restoration devices such as the Myosplint® were developed in the early 2000s to reshape left ventricular geometry and delay disease progression in patients with dilated cardiomyopathy. Despite initial safety and feasibility, long-term clinical efficacy remained limited. Today, patients with prior Myosplint® implantation may still present with end-stage heart failure requiring long-term mechanical circulatory support. However, device removal during HeartMate 3™ LVAD implantation may pose technical challenges due to altered myocardial anatomy. Case summary We report the case of a 65-year-old male with combined dilated and ischaemic cardiomyopathy and severe mitral valve regurgitation who had received two Myosplint® devices and mitral valve annuloplasty in 2001. After progressive decline in cardiac function, HeartMate 3™ LVAD implantation was indicated. During surgery, the Myosplint® tendons were clearly visible through the apical coring site and were transected close to their insertion points without complication. The epicardial buttons were left in situ. Mitral valve replacement was not performed, as significant reduction in regurgitation was expected through adequate LV unloading alone. Postoperative recovery was uneventful, and follow-up echocardiography confirmed only mild residual mitral insufficiency. Discussion Our case highlights a safe and straightforward technique for Myosplint® tendon management during HeartMate 3™ LVAD implantation. It also supports a conservative approach to mitral valve intervention in select cases, suggesting that adequate LV unloading alone may suffice to reduce regurgitation. This experience provides guidance for surgeons managing patients with prior mechanical restoration devices undergoing LVAD implantation.