Current and novel cardiac support therapies

Despite optimal medical therapy, many heart failure patients progress to end-stage disease associated with reduced quality of life and poor outcome. However, these patients can benefit from current novel cardiac support strategies, including ventricular assist devices (VADs), cardiac support devices (CSDs), and future cell- and/or matrix-based therapies. The most exciting goal in using VADs and CSDs is to achieve reverse remodeling, suppression of remodeling gene programs, and activation of myocardial recovery programs, which will improve left ventricular shape, size, and function. Long-term left VADs are effective, but recovery upon removal is uncommon. Passive CSDs (eg, Acorn devices) are very promising as long-term devices for therapy of end-stage heart failure and reversal of structural and biochemical remodeling. Expanding CSD use to include preventing progressive adverse left ventricular remodeling after ST-segment elevation myocardial infarction requires further study. The combination of cell- and/or matrix-based therapies with CSDs is under investigation.