Myocardial recovery: a focus on the impact of left ventricular assist devices

Abstract

Heart failure remains one of the most prevalent diseases worldwide and in recent decades, left ventricular assist devices (LVADs) have become an important treatment option. With increasing device experience, there is particular interest in the use of LVADs as a bridge to recovery that allows the patient’s heart to undergo reverse remodeling, whereby the device can be explanted and the heart can function at an improved state. There are many considerations that play a role in this process, including the ability of the device to unload the heart, the innate physiology of the heart to recover and the use of concomitant therapies. This review provides an overview of the most current literature as it pertains to these processes and gives a view into the future directions of LVADs as a tool for achieving myocardial recovery.

Keywords::

• heart failure
• myocardial recovery
• ventricular assist devices
• ventricular recovery
• ventricular remodeling

Financial & competing interests disclosure

This work was supported in part by Health Resources and Services Administration contract 234-2005-37011C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products or organizations imply endorsement by the U.S. Government. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Heart failure continues to be one of the most prevalent diseases, and effective treatment continues to be a difficult task.

• The potential for myocardial cells to reverse remodel is an intricate process involving multiple effects at mechanical, cellular and genetic levels.

• Left ventricular assist devices (LVADs) are evolving and improving and will undoubtedly continue to have a positive impact on ventricular unloading and reverse remodeling.

• Current literature continues to show promise in LVAD therapy as a method to allow bridge to recovery.

• To achieve adequate recovery will entail not only the use of LVADs alone, but in conjunction with other therapies, including pharmacologic as well as newly studied stem cell therapies.

• In order for a large randomized trial to evaluate the true effect of LVAD on recovery, there needs to be a standardization of the treatment regimen and weaning protocols. The ongoing RESTAGE trial has potential to do this.

• There are limitations to the implementation of LVADs in recovery including a defined protocol, follow-up methods and determination of length of therapy and the appropriate patient selection.