Abstract
Left ventricular assist devices (LVADs) have become the standard of care for treatment of patients with refractory end-stage heart failure (1-5). An LVAD results in decompression of the left ventricle, which promotes reverse remodeling, as manifested by decreased ventricular size, decreased mitral and tricuspid valve regurgitation and improved ventricular function. This process may play an important role in inducing left ventricular recovery with eventual explantation of the device. Right ventricular function and right-sided hemodynamics are also improved with LVAD therapy. Along with unloading of the right ventricle, there is a substantial reduction in central venous pressure (CVP), pulmonary artery pressure (PAP) and tricuspid regurgitation (TR). Consistent with the macroscopic changes seen on echocardiography as well as intracardiac pressures measured on right heart catheterizations, there are microscopic changes in the heart that are consistent with reverse remodeling after placement of an LVAD. These microscopic changes include changes in myocyte size, regression of fibrosis, cellular hypertrophy, collagen content, gene expression and various biomarkers of recovery, such as cardiac tumor necrosis factor-alpha (6-10).
Paper version not known (
Free)
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call