A 14-year-old boy undergoing long-term mechanical circulatory support with a left ventricular assist device (LVAD) developed myocardial abscess resulting from cannula exit-site infection. This critically ill patient was successfully treated with LVAD replacement and omentopexy following extensive myocardial debridement. Although the use of artificial materials in the face of active infection is not ideal, other options including LVAD explantation or urgent heart transplantation are not always feasible depending on the patient's cardiac function and the availability of a donor heart. Under such circumstances, LVAD replacement might be the only measure available that could save patients who otherwise would not survive.