Pathogenetic basis of myocardial dysfunction and amenability to reversal

As the role of the LVAD graduates from the "bridge-to-transplant" to the "bridge-to-recovery," several important issues need to be answered. Such a paradigm would require a definition of appropriate candidates for LVAD implantation, the most appropriate time for LVAD placement during the management of end-stage CHF, reliable histologic, biochemical, and imaging markers of recovery, and the optimum duration of LVAD support. The device technology must be refined further to reduce the morbidity associated with the device itself, and to make the device smaller, less invasive, and less thrombogenic. It will be a challenge to identify the role for concomitant drug therapy and to develop weaning programs for device support. Finally, guidelines will have to be developed to monitor and manage these patients after explantation of LVAD.