Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Oct;46(10):1154-1162.
doi: 10.1002/clc.24094. Epub 2023 Aug 1.

LVAD therapy as a catalyst to heart failure remission and myocardial recovery

Eman A Hamad  1 , Mirnela Byku  2 , Sharon B Larson  3 , Filio Billia  4
Affiliations
Review

LVAD therapy as a catalyst to heart failure remission and myocardial recovery

Eman A Hamad et al. Clin Cardiol. 2023 Oct.

Abstract

The management of chronic heart failure over the past decade has witnessed tremendous strides in medical optimization and device therapy including the use of left ventricular assist devices (LVAD). What we once thought of as irreversible damage to the myocardium is now demonstrating signs of reverse remodeling and recovery. Myocardial recovery on the structural, molecular, and hemodynamic level is necessary for sufficient recovery to withstand explant and achieve sustained recovery post-LVAD. Guideline-directed medical therapy and unloading have been shown to aid in recovery with the potential to successfully explant the LVAD. This review will summarize medical optimization, assessment for recovery, explant methodologies and outcomes post-recovery with explant of durable LVAD.

Keywords: GDMT; LVAD; explant; recovery.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Proposed protocol for weaning and assessment of recovery. CPX, cardiopulmonary exercise test; ECHO, echocardiogram; LV, left ventricle; LVAD, left ventricular assist device; MAP, mean arterial pressure; RHC, right heart catheterization.
Figure 2
Figure 2
Proposed algorithm for medical optimization, recovery assessment, and surgical considerations. ACEi, angiotensin‐converting enzyme inhibitors; ARB, angiotensin II receptor blocker; ARNI, angiotensin receptor‐neprilysin inhibitor; BB, β‐blocker; CI, cardiac index; CPX, cardiopulmonary exercise test; ECHO, echocardiogram; GDMT, guideline‐directed medical therapy; LVAD, left ventricular assist device; LVEDD, left ventricular end‐diastolic diameter; LVEF, left ventricular ejection fraction; RHC, right heart catheterization; SGLT2i, sodium‐glucose cotransporter 2 inhibitor.
See this image and copyright information in PMC

References

    1. Bleumink G, Knetsch A, Sturkenboom M, et al. Quantifying the heart failure epidemic: prevalence, incidence rate, lifetime risk and prognosis of heart failure: The Rotterdam Study. Eur Heart J. 2004;25(18):1614‐1619. - PubMed
    1. Rose EA, Gelijns AC, Moskowitz AJ, et al. Long‐term use of a left ventricular assist device for end‐stage heart failure. N Engl J Med. 2001;345(20):1435‐1443. - PubMed
    1. Mehra MR, Goldstein DJ, Cleveland JC, et al. Five‐year outcomes in patients with fully magnetically levitated vs axial‐flow left ventricular assist devices in the MOMENTUM 3 Randomized Trial. JAMA. 2022;328(12):1233‐1242. - PMC - PubMed
    1. Marinescu KK, Uriel N, Mann DL, Burkhoff D. Left ventricular assist device‐induced reverse remodeling: it's not just about myocardial recovery. Expert Rev Med Devices. 2017;14(1):15‐26. - PMC - PubMed
    1. Birks EJ, George RS, Hedger M, et al. Reversal of severe heart failure with a continuous‐flow left ventricular assist device and pharmacological therapy: a prospective study. Circulation. 2011;123(4):381‐390. - PubMed