Myocardial Recovery During LVAD Support
Heart failure (HF) is characterized by a pathologic process known as remodeling that involves progressive enlargement of the ventricle, reduction in contractility, and an increase in intracardiac pressures. Patients with chronic advanced HF supported with a left ventricular assist device (LVAD) that provides unloading of the ventricle can show significant improvements of these abnormalities, or “reverse remodeling.” Histologic examination showed the mean area of attenuated myocytes to be reduced from 60 to 21% from the time of implantation compared to after mechanical circulatory support. This was the first report suggesting that significant improvement of cardiac structure and function was possible with LVAD support. These findings are often associated with significant recovery of the underlying cardiac function, sufficient to allow for removal of the LVAD (myocardial recovery or “remission” of HF). Advanced HF patients have the potential to improve their cardiac structure and function while on LVAD support.
