Ouch.. that hurts to read.  I kind of figured there were more painful details, and you were likely correct to present a more abbreviated version in your opening post getting into the topic.

People can function and appear somewhat "normal" if their left ventricle ejection fractions are between 25% and 35%.. even though that is quite low and they may well have issues with heart stability too, and I believe that eligibility for a defibrillator implantation is usually something like low 30% and below but there could be some other aggravating factors to justify a defibrillator even if the ejection is higher than 30%.. that would be not merely looking at LVEF, and of course the higher the left ventricle ejection fraction the more likely a person is able to appear "normal," even if s/he might have inabilities to exert or to sustain exertion. 

Surely with the left ventricle ejection fraction there can be some measurement variability too, so sometimes the doctor might look at a few different tests that measure it and then to average out the measurements or to assert that the methodology of one measurement was likely more accurate than another one or series of measurements.. so yes, maybe you did actually have material and concrete improvement that was confirmed and NOT merely measurement variability or a fluke, but then like you suggest and found out, the recovery that you were having was not sustainable… and sometimes there could be other things going on such as the implantation of the valve is not really working very well and there might not really be any ability to implant another valve.. or maybe you cannot be sure at what point your heart became irreversibly damaged…. So for example all could have been going well and recovering.. but then your valve was not working properly and at some point you were experiencing further irreversible heart death (ischemia and/or scaring) without even knowing it.. and really difficult for anyone to know sometimes if it is not caught right away..    There are some theories that the heart tissue cannot really recover if it has not gotten adequate oxygen/blood flow for 12 hours or more, but even those kinds of theories are incomplete because there could be some heart tissues that are getting some blood circulation and other tissues that are completely not getting any blood circulation. .so there could still be some recoverability of some heart tissue.. but even that is not easy to measure.. even with a shitload of tests.

I would not be surprised if the medical folks might have been having some troubles figuring out why your recovery was not sustaining and why your ejection fraction had gone up so much and then fallen again so quickly back down to really a deadly status.. sub 20%...pretty much like it was when you were in your earlier bad situation in late 2021.. . which really, as you know, having those kinds of lack of blood flow to your body likely makes it difficult to do anything without losing energy…or even some basic things like having feelings (or warmth) in your extremities… and probably more susceptible to infections too because the blood and the oxygen is not really getting around very well.  so yes thanks for the posts. and even taking time to read and to type.. because sometimes those kinds of activities can wear on any of us, and even talking, or trying to yell might cause chestpain and other symptoms if you get stressed out about any of these kinds of matters....  though surely you are taking some medications that likely help you with some of these matters, but there is nothing as effective as having actually functioning natural organs because the various drug inducements have a lot of limitations, too… and side effects as you likely experience.

You surely have pointed out that some of the heart related and functional tests that you received seem redundant and then also there may be a lot of time for doctors trying to figure out and to confirm various specifics of your condition or what is causing it.. or could be causing it.. or appear to be causing it (even though surely they seemed to have had figured out a lot of the matters by now and even ruled out other explanations), and even like you mentioned, your insurance company seemed to have needed (or wanted) (and sometimes burdensome too) their own verification to make sure that test-related or expert opinion errors were not being relied upon in order to confirm your diagnosis or to confirm your prognosis for recovery, too.

For sure, I don't really know some of the details that you talk about in relation to your specific details because many times there are going to be individual variations in terms of which vessels are affected or what type of equipment is used and where is the defibrillator implanted (and likely pacemaker function too).  Also, I am not even claiming to be any kind of expert, but just have some specific knowledge of some of the areas in which you had been describing.

I would think with your LVEF so low, you will likely feel better when you have a heart pump (or ventricular assist or whatever variation you end up receiving) and from my understanding, those do not really tend to be very long-term kinds of solutions because of infection potentials and body rejections and various sensitivities.. but surely it may well help you to feel way better during the interim while waiting for a compatible heart (and some folks have more possibilities for compatibility with actual new hearts (or should we say used hearts?) than others based on blood typing and some other compatibility considerations).. even though probably a kind of pain in the ass to have one surgery after another in order to try to make sure that you are ready or that you are able to function or that you are not suffering additional damage while waiting yet I understand that when you get into a state in which you don't have a choice because you can hardly move without getting symptoms, then likely you welcome those various interventions such as having the temporary heart pump.. because it might be one of the better and less risky options given your particular situation.   

Regarding the long-lived forum thread (or blog) that I had suggested, that was my dorky way of trying to hope that you are able to make it through your heart transplant and then have enough of a recovery (and even excess energy) to be able to just end up being able to spend time on seemingly silly things.. for another 50-ish years... it is likely that the last year you spent way more time with tests and doctors, and sure some of it can be interesting, but it may well not be a preferred way of spending time…. even though it is surely the most pressing of issues at the time.. so  that surely make sense, and we surely have to do what we have to do when certain vital organs fail or are underperforming... and sometimes even if we are doing something that we do not prefer, we figure out some way to make the best of out what seems to be a less than preferable situation. 

No need to feel that you need to respond to me if I may have typed too much, again.