Reverse cardiac remodeling enabled by mechanical unloading of the left ventricle.
Cardiac remodeling is a characteristic and basic component of heart failure progression and is associated with a poor prognosis. Attenuating or reversing remodeling is an accepted goal of heart failure therapy. Cardiac mechanical support with left ventricular assist devices, in addition to its established role as "bridge to transplantation" or "destination therapy" in patients not eligible for cardiac transplantation, offers the potential for significant and sustained myocardial recovery through reverse remodeling. This review discusses the emerging role of left ventricular assist devices as a "bridge to recovery". Clinical and basic aspects of cardiac remodeling and cardiac reverse remodeling enabled by mechanical unloading, potential candidates for this modality of treatment as well as unresolved issues regarding the use of mechanical circulatory support as a bridge to recovery are discussed.
Malliaras
Konstantinos G
KG
Third Cardiology Department, University of Athens, Athens, Greece.
Terrovitis
John V
JV
Drakos
Stavros G
SG
Nanas
John N
JN
D000818:Animals; D018450:Disease Progression; D006333:Heart Failure / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D020127:Recovery of Function; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling