Magnitude and Time Course of Changes Induced by Continuous-Flow Left Ventricular Assist Device Unloading in Chronic Heart Failure: Insights into Cardiac Recovery

Wever‐Pinzon, Omar; Kfoury, A.G.; Selzman, Craig H.; Reid, B.B.; Alharethi, Rami; Budge, D.; Gilbert, E.M.; McKellar, Stephen H.; Caine, W.T.; Verma, Divya Ratan; Saïdi, A.; Brunisholz, Kimberly D.; Stehlik, J.; Drakos, Stavros

doi:10.1016/j.healun.2013.01.880

Cited by 2 publications

(3 citation statements)

References 23 publications

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“…There is general agreement about the importance of ECHO in ascertaining the necessity and feasibility of LVAD support, taking decisions about the need for an additional assist device also for the right-sided heart in LVAD candidates, intraoperative guiding of VAD implantation and adjustment of the assist device flow, as well as post-operative monitoring of the ventricular support including accurate monitoring of the right-sided heart in LVAD recipients (Table 2 , Ref. [ 3 , 4 , 5 , 6 , 7 , 11 , 22 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 ...…”

Section: Role Of Echocardiography In Ventricular Assist Device Therapymentioning

confidence: 99%

“…By lowering the myocardial wall-tension and optimization of blood flow into vital organs, LVADs and BiVADs can remove the major pathophysiological stimuli for cardiac remodeling and interrupt the vicious circle of ventricular dilation and reduction of the efficiency of myocardial contraction [ 89 , 90 , 91 , 92 , 93 , 94 ]. All this facilitates reverse remodeling even in patients with chronic NICMP and can be accompanied by clinically relevant reversal of LV structural and functional alterations allowing sometimes even removal of the VAD.…”

Section: Surveillance Of Vad Recipients By Echocardiographymentioning

confidence: 99%

“…Regular TTE screenings with normal LVAD support are necessary for identification of potential weaning candidates. Potential weaning candidates are those with signs of LV reverse remodeling (including normalization of the LVEDD), improvement of wall motion (LV fractional shortening

15%), no relevant cardiac valve regurgitations and no RV dilation during full LVAD support [ 89 , 90 , 91 ]. Repeated short-term interruptions of LV unloading (off-pump or turn-down trials) are essential for recovery assessment.…”

Section: Surveillance Of Vad Recipients By Echocardiographymentioning

confidence: 99%

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Role of Echocardiography in the Management of Patients with Advanced (Stage D) Heart Failure Related to Nonischemic Cardiomyopathy

Dandel¹

2022

Rev. Cardiovasc. Med.

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Echocardiography (ECHO) is indispensable for evaluation of patients with terminal chronic heart failure (HF) who require transplantation or mechanical circulatory support by a left- or biventricular assist device (LVAD or BiVAD, respectively). In LVAD candidates, ECHO represents the first-line investigation necessary for a timely discovery of heart-related risk factors for potentially life-threatening post-operative adverse events, including identification of patients who necessitate a biventricular support. ECHO is also required for intra-operative guiding of VAD implantation and finding of the most appropriate setting of the device for an optimal ventricular unloading, postoperative surveillance of the VAD support, and monitoring of the RV changes in LVAD recipients. Thanks to the ECHO, which has decisively contributed to the proof that prolonged VAD support can facilitate cardiac reverse remodeling and functional improvement to levels which allow successful weaning of carefully selected patients from LVAD or BiVAD, the previous opinion that chronic non-ischemic cardiomyopathy (NICMP) is irreversible could be refuted. In patients with normalized and stable right heart catheter-derived hemodynamic parameters obtained at short-term interruptions of VAD support, ECHO has proved able to predict post-weaning long-term freedom from HF recurrence in patients with pre-implant terminal chronic NICMP. The purpose of this article is to offer an actualized theoretical and practical support for clinicians engaged in this particularly challenging and topical issue especially due to the new practical aspects which have emerged in conjunction with the growing use of long-term ventricular assist devices as bridge-to-transplantation or as destination therapy, as well as the increasing evidence that, in some patients, such VAD can become a bridge-to-recovery, allowing the removal of the device after a longer support time.

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Section: Role Of Echocardiography In Ventricular Assist Device Therapymentioning

confidence: 99%

Section: Surveillance Of Vad Recipients By Echocardiographymentioning

confidence: 99%

Section: Surveillance Of Vad Recipients By Echocardiographymentioning

confidence: 99%

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Role of Echocardiography in the Management of Patients with Advanced (Stage D) Heart Failure Related to Nonischemic Cardiomyopathy

Dandel¹

2022

Rev. Cardiovasc. Med.

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Ventricular Assist Devices in Heart Failure: How to Support the Heart but Prevent Atrophy?

Pokorný

Červenka²,

Netuka³

et al. 2014

Physiol Res

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Ventricular assist devices (VAD) have recently established themselves as an irreplaceable therapeutic modality of terminal heart failure. Because of the worldwide shortage of donors, ventricular assist devices play a key role in modern heart failure therapy. Some clinical data have revealed the possibility of cardiac recovery during VAD application. On the other hand, both clinical and experimental studies indicate the risk of the cardiac atrophy development, especially after prolonged mechanical unloading. Little is known about the specific mechanisms governing the unloading-induced cardiac atrophy and about the exact ultrastructural changes in cardiomyocytes, and even less is known about the ways in which possible therapeutical interventions may affect heart atrophy. One aim of this review was to present important aspects of the development of VAD-related cardiac atrophy in humans and we also review the most significant observations linking clinical data and those derived from studies using experimental models. The focus of this article was to review current methods applied to alleviate cardiac atrophy which follows mechanical unloading of the heart. Out of many pharmacological agents studied, only the selective beta2 agonist clenbuterol has been proved to have a significantly beneficial effect on unloading-induced atrophy. Mechanical means of atrophy alleviation also seem to be effective and promising.

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Magnitude and Time Course of Changes Induced by Continuous-Flow Left Ventricular Assist Device Unloading in Chronic Heart Failure: Insights into Cardiac Recovery

Cited by 2 publications

References 23 publications

Role of Echocardiography in the Management of Patients with Advanced (Stage D) Heart Failure Related to Nonischemic Cardiomyopathy

Role of Echocardiography in the Management of Patients with Advanced (Stage D) Heart Failure Related to Nonischemic Cardiomyopathy

Ventricular Assist Devices in Heart Failure: How to Support the Heart but Prevent Atrophy?

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