Mechanical unloading and heart remodeling features


Book Section

© Springer-Verlag London 2013. Left ventricular assist devices (LVADs) are increasingly used in the everyday clinical practice to either �bridge� end-stage heart failure (HF) patients to heart transplantation or as a permanent (�destination�) therapy. Myocardial remodeling driven by excess pressure and volume load is believed to be responsible for the vicious cycle of progressive myocardial dysfunction in chronic HF [1]. This mechanistic model led to the hypothesis that LVAD support would disrupt this cycle and, by providing profound volume and pressure unloading, allow for a reversal of stress-related compensatory responses of the overloaded myocardium [2� 4]. This in turn would lead to subsequent structural and functional �reverse remodeling� at organ and tissue levels [2� 4]. Limited clinical data have suggested that LVAD therapy can occasionally reverse the complex process of chronic myocardial remodeling to the point where a subset of patients can be successfully weaned from the LVAD (�bridge to recovery�) [5� 8]. Achieving sustained myocardial recovery after LVAD explantation in a patient with chronic HF is one of the most desirable goals in the treatment of heart disease [9]. Consequently, the mechanisms that might facilitate LVAD unloading-induced myocardial reverse remodeling have become the subject of intensive research [2� 4], and this has been favored by the fact that the LVAD patient population possesses a series of signi fi cant research advantages. However, fundamental questions at the basic science, translational, and clinical level remain unanswered

Full Text

Duke Authors

Cited Authors

  • Diakos, NA; Wever-Pinzon, O; Drakos, SG

Published Date

  • January 1, 2013

Book Title

  • Inflammatory Response in Cardiovascular Surgery

Start / End Page

  • 413 - 418

International Standard Book Number 13 (ISBN-13)

  • 9781447144281

Digital Object Identifier (DOI)

  • 10.1007/9781447144298_49

Citation Source

  • Scopus