Myocardial Recovery After LVAD Implantation: A Vision or Simply an Illusion?
نویسندگان
چکیده
I n 1966, following a 4-h surgery, Dr. DeBakey implanted a left ventricular assist device (LVAD) in a patient experiencing post-cardiotomy shock. The patient was kept alive for 10 days until her own heart healed. This case has been recognized as the first successful use of an LVAD and has inspired the dream thatmyocardial recovery can occur when a failing heart is rested during LVAD. Over time, a consensus was established that myocardial recovery might occur in acute situations like the case from 1966. However, the question of myocardial recovery in patients with chronic heart failure (CHF) remained elusive. It was not until 1996 that the first report of ventricular reverse remodeling and apparent recovery was reported in a 19-year-old man with chronic heart failure (1); this “recovery” proved to be temporary, with reemergence of the CHF phenotype within days of LVAD explant. It was not until 10 years later, in 2006, that the seminal and controversial work by Birks et al. (2) from the Harefield group impressed the heart failure community by reporting an extremely high success rate of LVAD explantation. In their study, 73.3% of the patients implanted with durable LVAD (HeartMate XVE, Thoratec, Pleasanton, California) and treated with neurohormonal blockade and clenbuterol exhibited myocardial recovery, including normalization of left ventricular (LV) ejection fraction and the ability to wean off and ultimately explant the device. However,
منابع مشابه
Birks Molecular Changes With LVAD Unloading and Recovery 779
Circulation Research is available at http://circres.ahajournals.org DOI: 10.1161/CIRCRESAHA.113.301413 Abstract—Heart failure is associated with remodeling that consists of adverse cellular, structural, and functional changes in the myocardium. Until recently, this was thought to be unidirectional, progressive, and irreversible. However, irreversibility has been shown to be incorrect because co...
متن کاملMolecular Changes After Left Ventricular Assist Device Support for Heart Failure Emma
Circulation Research is available at http://circres.ahajournals.org DOI: 10.1161/CIRCRESAHA.113.301413 Abstract—Heart failure is associated with remodeling that consists of adverse cellular, structural, and functional changes in the myocardium. Until recently, this was thought to be unidirectional, progressive, and irreversible. However, irreversibility has been shown to be incorrect because co...
متن کاملCardiac improvement during mechanical circulatory support: a prospective multicenter study of the LVAD Working Group.
BACKGROUND Myocardial recovery after left ventricular assist device (LVAD) support has been reported. The LVAD Working Group Recovery Study was a prospective multicenter trial to assess the incidence of myocardial recovery in patients bridged to cardiac transplantation. METHODS AND RESULTS After LVAD implantation, patients were evaluated with the use of rest echocardiograms with partial LVAD ...
متن کاملMolecular changes after left ventricular assist device support for heart failure.
Heart failure is associated with remodeling that consists of adverse cellular, structural, and functional changes in the myocardium. Until recently, this was thought to be unidirectional, progressive, and irreversible. However, irreversibility has been shown to be incorrect because complete or partial reversal can occur that can be marked after myocardial unloading with a left ventricular assis...
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BACKGROUND Advanced systolic heart failure is associated with myocardial and systemic metabolic abnormalities, including low levels of total cholesterol and low-density lipoprotein. Low cholesterol and low-density lipoprotein have been associated with greater mortality in heart failure. Implantation of a left ventricular assist device (LVAD) reverses some of the metabolic derangements of advanc...
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عنوان ژورنال:
- Journal of the American College of Cardiology
دوره 70 3 شماره
صفحات -
تاریخ انتشار 2017