LVAD as a Bridge to Remission from Advanced Heart Failure: Current Data and Opportunities for Improvement

Kyriakopoulos, Christos P.; Kapelios, Chris J.; Stauder, Elizabeth L.; Taleb, Iosif; Hamouche, Rana; Sideris, Konstantinos; Koliopoulou, Antigone; Bonios, Michael; Drakos, Stavros G.

doi:10.3390/jcm11123542

Cited by 11 publications

(21 citation statements)

References 122 publications

(315 reference statements)

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“…Thus, there is a need to design studies with disease- and intervention-specific patient inclusion criteria, consistent medication protocols and monitoring protocols to determine true myocardial dimensions for recovery. Myocardial recovery should be an intensive field of study in the coming years [ 61 , 65 ]. This is evident from the tendency of now official organizations to recategorize these patients, for example, the American Heart Association (AHA), which created the HFimpEF classification for patients, studied as a separate group those who, after therapeutic interventions, improved their cardiac function ( Figure 5 ).…”

Section: Discussionmentioning

confidence: 99%

“…Several studies, both prospective and retrospective, have demonstrated the association between the use of neurohormonal inhibitors and reverse remodeling in patients with LVADs [ 42 , 43 , 60 , 61 ]. An interesting retrospective analysis of 12,144 LVAD patients from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) revealed that those receiving any neurohormonal inhibitor at 6 months had a better survival rate at 4 years compared with patients not receiving neurohormonal inhibitor (56.0% vs. 43.9%) [ 62 ].…”

Section: Medical Treatment and Cardiac Rehabilitationmentioning

confidence: 99%

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Myocardial Recovery

et al. 2023

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In this paper, the feasibility of myocardial recovery is analyzed through a literature review. First, the phenomena of remodeling and reverse remodeling are analyzed, approached through the physics of elastic bodies, and the terms myocardial depression and myocardial recovery are defined. Continuing, potential biochemical, molecular, and imaging markers of myocardial recovery are reviewed. Then, the work focuses on therapeutic techniques that can facilitate the reverse remodeling of the myocardium. Left ventricular assist device (LVAD) systems are one of the main ways to promote cardiac recovery. The changes that take place in cardiac hypertrophy, extracellular matrix, cell populations and their structural elements, β-receptors, energetics, and several biological processes, are reviewed. The attempt to wean the patients who experienced cardiac recovery from cardiac assist device systems is also discussed. The characteristics of the patients who will benefit from LVAD are presented and the heterogeneity of the studies performed in terms of patient populations included, diagnostic tests performed, and their results are addressed. The experience with cardiac resynchronization therapy (CRT) as another way to promote reverse remodeling is also reviewed. Myocardial recovery is a phenomenon that presents with a continuous spectrum of phenotypes. There is a need for algorithms to screen suitable patients who may benefit and identify specific ways to enhance this phenomenon in order to help combat the heart failure epidemic.

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Section: Discussionmentioning

confidence: 99%

Section: Medical Treatment and Cardiac Rehabilitationmentioning

confidence: 99%

Myocardial Recovery

et al. 2023

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“…Recent studies show that continuous flow LVADs can improve the survival of end-stage heart failure patients and have been in current clinical use as a destination therapy or as a bridge-to-transplant ( 1 – 3 ). However, the use of LVAD has been reported to cause aortic insufficiency (AI), as early as 6 months, requiring continuous hemodynamic monitoring of the aortic valve (AV) post implantation ( 1 , 3 ). The pathophysiology of this LVAD-associated AI is partly related to the impact of the LVAD, causing degenerative changes and remodeling of the AV ( 4 , 5 ).…”

Section: Introductionmentioning

confidence: 99%

“…The surgical repair of the AV in the context of LVAD-associated anatomical remodeling generally includes ring annuloplasty ( 8 ). However, reports show that AV regurgitation can develop even after AV repair within a few months of LVAD implantation with concomitant annuloplasty ( 3 , 8 , 9 ). Hence, concomitant AVR with ring annuloplasty during LVAD implantation has been adopted and reported with feasible outcomes ( 8 , 9 ).…”

Section: Introductionmentioning

confidence: 99%

Case report: A novel surgical technique for rapid valve-in-ring implantation into the native aortic annulus during left ventricular assist device implantation

Pya¹,

Mussayev

Novikova³

et al. 2023

Front. Cardiovasc. Med.

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The implantation of a left ventricular assist device (LVAD) has become an essential requirement for managing patients with end-stage heart failure. However, aortic valve insufficiency is a contraindication for LVAD implantation in patients with end-stage heart failure, partly because of the decreasing efficiency of mechanical circulatory support and the eventual development of right ventricular failure. Herein, we present the first case of performing transcatheter aortic valve replacement in valve-in-ring along with LVAD implantation for the treatment of a 60-year-old male suffering from refractory heart failure due to dilated cardiomyopathy and pure aortic insufficiency in need of a new aortic bioprosthesis. A balloon-expandable bioprosthetic transcatheter heart valve was implanted into a previously sewn annulus ring into the aortic root via transaortic access. Subsequently, a centrifugal-flow LVAD was implanted. Postoperatively, the patient was in New York Heart Association Functional Class (NYHA) II with 6-min walk test of 310 m. The patient has completed 6 months of follow-up with no events. This novel and feasible surgical technique reduced the cardiopulmonary bypass time and duration of surgery. Furthermore, it avoids the risk of redo sternotomy and decreases the chances of paravalvular leakage and worsening of aortic regurgitation.

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“…The correct operation of the valves ensures an appropriate hemodynamic state of the human being and the correct perfusion of organs, as well as tissue microperfusion. The valves, however, can be destroyed for various reasons [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Hemocompatibile Thin Films Assessed under Blood Flow Shear Forces

et al. 2022

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The aim of this study was to minimize the risk of life-threatening thromboembolism in the ventricle through the use of a new biomimetic heart valve based on metal–polymer composites. Finite volume element simulations of blood adhesion to the material were carried out, encompassing radial flow and the cone and plane test together with determination of the effect of boundary conditions. Both tilt-disc and bicuspid valves do not have optimized blood flow due to their design based on rigid valve materials (leaflet made of pyrolytic carbon). The main objective was the development of materials with specific properties dedicated to contact with blood. Materials were evaluated by dynamic tests using blood, concentrates, and whole human blood. Hemostability tests under hydrodynamic conditions were related to the mechanical properties of thin-film materials obtained from tribological tests. The quality of the coatings was high enough to avoid damage to the coating even as they were exposed up to maximum loading. Analysis towards blood concentrates of the hydrogenated carbon sample and the nitrogen-doped hydrogenated carbon sample revealed that the interaction of the coating with erythrocytes was the strongest. Hemocompatibility evaluation under hydrodynamic conditions confirmed very good properties of the developed coatings.

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LVAD as a Bridge to Remission from Advanced Heart Failure: Current Data and Opportunities for Improvement

Cited by 11 publications

References 122 publications

Myocardial Recovery

Myocardial Recovery

Case report: A novel surgical technique for rapid valve-in-ring implantation into the native aortic annulus during left ventricular assist device implantation

Hemocompatibile Thin Films Assessed under Blood Flow Shear Forces

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