Oct 14, 2014 - Promoting Myocardial Recovery With Ventricular Assist Device*. Hao A. Tran ... data correlating the direct effect of mechanical unloading with ...
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