Current and novel cardiac support therapies

Abstract

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.

Mechanical Approach in the Management of Advanced Acute and Chronic Heart Failure

“…The MCS ascertains various therapeutic objectives (treatment end point) that include bridge to transplant (BTT), bridge to eligibility, bridge to bridge, bridge to recovery, bridge to next decision, and destination therapy. 2,6 Bridge to Transplant. The approach of BTT utilizes a MCS device that is a temporary implant intended to support blood flow in patients with severe AHF until an appropriate heart donor is available.…”

“…The use of VADs and CSDs primarily aims to attain the reverse remodeling, inhibition of remodeling gene events, and initiation of myocardial recovery programs (Table 1), which will substantiate the recovery of left ventricular geometry (shape and size) and function. 2 Cardiac transplantation and use of MCS devices are the 2 therapeutic alternatives that need extensive exploration in acute heart failure syndrome (AHFS). Although cardiac transplantation is considered as the gold standard for AHF treatment, availability of donors is the major limitation of this strategy.…”

“…Novel cardiac support strategies such as new pharmacologic agents, MCS, and cell- or matrix-based therapies proved to be promising for these patients. 2 Of these strategies, MCS is of particular importance and includes ventricular assist devices (VADs) and cardiac support devices (CSDs). The use of VADs and CSDs primarily aims to attain the reverse remodeling, inhibition of remodeling gene events, and initiation of myocardial recovery programs (Table 1), which will substantiate the recovery of left ventricular geometry (shape and size) and function.…”

Mechanical circulatory support for elderly heart failure patients

“…Much work has been done evaluating the effects of such unloading on left ventricular morphology, hemodynamics, and histology [31,32]. Despite this so-called reverse remodeling, only a few percent of patients achieve sufficient recovery of left ventricular function to have the MCS device successfully removed (i.e., bridge to recovery) [4,33].…”

Systolic heart failure in the elderly: optimizing medical management

“…VADs may be used for right (RVAD), left (LVAD) or biventricular (BiVAD) short-or long-term support. VAD support, usually LVAD or BiVAD, can be used in acutely decompensated patient and then either with bridge to recovery, bridge to bridge and bridge to next step (transplantation) [78]. While transplant policies vary from locale to locale, advanced age is a relative contraindication to cardiac transplantation.…”