<h3>Introduction</h3> Cardiac recovery followed by LVAD-explantation is rare and happens only in 1-2% of the cases. Tracheal rupture during tracheotomy is an even more rare but dreaded complication. <h3>Case Report</h3> We report the case of a 60 year old female patient who had received LVAD therapy (HeartWare) six years ago for DCM caused by myocarditis. She had an uncomplicated course for four years, had one medically treated episode of systemic infection after five years and recently sepsis together with minor cerebral bleeding. After recovery, a CT-scan showed infection of the LVAD including the outflow graft. As echocardiography and right heart catheterization revealed sufficiently recovered cardiac function, the decision for LVAD-explantation was made. The device was successfully explanted via a median re-sternotomy and the complete outflow graft was removed. The patient was stable and extubated on the 1. POD, but needed to be re-intubated on the 4. POD due to pneumonia. As prolonged weaning from the respirator was expected, the patient underwent a tracheotomy. Shortly after, she developed a severe emphysema, could not be sufficiently ventilated and received an emergency implantation of a VV-ECMO. Bronchoscopy showed a large laceration of the back wall of the trachea. This was repaired surgically by direct suture and two days later a re-operation to cover the tracheal laceration with an intercostal muscle flap was required. After this, the patient developed recurrent bleedings with hemothorax and the need for multiple re-thoracotomies. The patient was on VV-ECMO for two weeks without ventilation or blockage of the tube-cuff to allow the trachea to heal. After bronchoscopic confirmation of good tracheal healing, careful ventilation was initiated. The pulmonary function recovered and the ECMO could be explanted after 36 days. Further along the patient was discharged to a pulmonary weaning clinic. She further recovered and is currently in good shape with NYHA class I-II. Interestingly, during the course of this dramatic complication, the patient was always in good cardiac function without any need of inotropic support. <h3>Summary</h3> After complete cardiac recovery and successful LVAD-explantation even a close to fatal complication like a tracheal rupture can be survived with good clinical outcome. Avoiding mechanical stress to the lacerated trachea under VV-ECMO might be a promising strategy.