Often Talked About, Seldom Seen - JACC

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

VOL. 64, NO. 15, 2014

ª 2014 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION

ISSN 0735-1097/$36.00

PUBLISHED BY ELSEVIER INC.

http://dx.doi.org/10.1016/j.jacc.2014.07.965

EDITORIAL COMMENT

Often Talked About, Seldom Seen Promoting Myocardial Recovery With Ventricular Assist Device* Hao A. Tran, MD, Jorge Silva Enciso, MD, Eric D. Adler, MD

V

entricular assist devices (VADs) have funda-

has been shown to be superior over another. Studies

mentally changed the treatment of end-

of patients on mechanical circulatory support evalu-

stage heart failure. However, despite great

ated with serial echocardiography and invasive he-

advances, long-term VAD use is still associated with

modynamics demonstrated a relative improvement

frequent

complications,

in LV systolic function, a decrease in intraventricular

and a 2-year survival of approximately 70% (1).

dimension indices (LV end-diastolic and end-systolic

Although myocardial recovery has long been touted

volume), and an improvement in diastolic parame-

hospitalizations,

serious

as the holy grail of mechanical circulatory support,

ters after VAD implantation (7,8). However, limited

true myocardial recovery, in which function returns

data correlating the direct effect of mechanical

to normal, is unfortunately akin to urban legend:

unloading with myocyte function, myocardial endo-

often discussed but seldom seen. According to the

thelium, and microvasculature are available. Previous

Interagency Registry for Mechanically Assisted Circu-

studies illustrated regression of hypertrophy and

latory Support, functional recovery leading to explant

even cardiac myocyte atrophy (9,10). Although in-

occurs in