Long-Term Survival Under Biventricular Assist Device Support Despite Persistent Asystole

We report a unique case of a 45 year old man with biventricular assist device (BiVAD) support who has remained asymptomatic despite a complete absence of native cardiac electrical and mechanical activity for 43 months. The patient exhibited persistent asystole with stable hemodynamics, oxygenation, and device flows. Echocardiography confirmed absent contractility and continuously open atrioventricular valves. This case illustrates that BiVAD support can maintain adequate systemic and pulmonary circulation even in the absence of intrinsic cardiac activity, representing the longest reported survival under sustained asystole.