Left ventricular assist device support induces significant reverse remodeling, but very few patients achieve sufficient functional recovery to justify explantation without subsequent relapse.
LVAD support induces reverse remodeling in dilated cardiomyopathy, but true myocardial recovery allowing for device explantation is rare and often temporary, highlighting the need for adjunctive therapies.
INTRODUCTION: The abnormal structure, function and molecular makeup of dilated cardiomyopathic hearts can be partially normalized in patients supported by a left ventricular assist device (LVAD), a process called reverse remodeling. This leads to recovery of function in many patients, though the rate of full recovery is low and in many cases is temporary, leading to the concept of heart failure remission, rather than recovery. Areas covered: We summarize data indicative of ventricular reverse remodeling, recovery and remission during LVAD support. These terms were used in searches performed in Pubmed. Duplication of topics covered in depth in prior review articles were avoided. Expert commentary: Although most patients undergoing mechanical circulatory support (MCS) show a significant degree of reverse remodeling, very few exhibit sufficiently improved function to justify device explantation, and many from whom LVADs have been explanted have relapsed back to the original heart failure phenotype. Future research has the potential to clarify the ideal combination of pharmacological, cell, gene, and mechanical therapies that would maximize recovery of function which has the potential to improve exercise tolerance of patients while on support, and to achieve a higher degree of myocardial recovery that is more likely to persist after device removal.
Marinescu et al. (Tue,) conducted a review in Dilated cardiomyopathy and heart failure. Left ventricular assist device (LVAD) was evaluated. Left ventricular assist device support induces significant reverse remodeling, but very few patients achieve sufficient functional recovery to justify explantation without subsequent relapse.