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Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock
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Bridge to removal: a paradigm shift for left ventricular assist device therapy
Craig H Selzman1, Jesse L Madden1, Aaron H Healy1
1Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, Utah.
The Annals of Thoracic Surgery
|December 3, 2014
Summary
Ventricular assist devices (VADs) support advanced heart failure patients. While VADs can promote cardiac recovery, explantation remains rare, prompting research into VADs as a bridge to myocardial recovery and removal.
Area of Science:
- Cardiology
- Biomedical Engineering
- Heart Failure Research
Background:
- Ventricular assist devices (VADs) are standard for advanced heart failure, serving as a bridge to transplant or destination therapy.
- Despite evidence of reverse cardiac remodeling, myocardial recovery sufficient for device explantation is infrequent.
- This highlights a gap between VAD support capabilities and actual patient recovery outcomes.
Purpose of the Study:
- To review current challenges and strategies for achieving myocardial recovery in VAD-supported patients.
- To explore the potential of VADs as a bridge to myocardial recovery and subsequent device removal.
- To shift the paradigm from VADs solely for support to VADs as a tool for potential heart recovery.
Main Methods:
- Literature review of studies on VADs and myocardial recovery.
- Analysis of biological and functional evidence of reverse cardiac remodeling.
- Examination of clinical approaches and patient care strategies in mechanically supported patients.
Main Results:
- VADs demonstrate functional and biological potential for reverse cardiac remodeling.
- Current protocols and understanding limit the number of patients achieving recovery for device explantation.
- Emerging research focuses on optimizing conditions for myocardial recovery during VAD support.
Conclusions:
- Transforming VADs into a reliable bridge to myocardial recovery requires a deeper understanding of underlying biology.
- Innovative care strategies and therapeutic interventions are crucial for enhancing recovery potential.
- Further research is needed to make VAD explantation a practical reality for a larger patient cohort.
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