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Device therapy

LVADs as a bridge to recovery

Nature Reviews Cardiology volume 8, page 120 (2011)Cite this article

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Second-generation, continous-flow left ventricular assist devices (LVADs) can be used in combination with pharmacological therapy to reverse severe heart failure, report Birks and colleagues. Pulsatile LVADs have been used to improve the durability of recovery in patients with dilated cardiomyopathy, but the use of continous-flow LVADs for this purpose is an exciting new development.

This prospective study included 20 patients with nonischemic dilated cardiomyopathy who had received a continuous-flow LVAD as a bridge to transplantation. Aggressive drug therapy (lisinopril, carvedilol, spironolactone, digoxin and losartan) in combination with unloading of the myocardium using the LVAD was used to maximize reverse remodeling. Progress was monitored monthly by echocardiographic measurements of the left ventricle with the LVAD pump running at minimal speed. Once the heart had reached normal size, carvedilol was switched to bisoprolol, and clenbuterol was added to strengthen the heart muscle. Of the 12 patients who recovered and underwent device explantation, two died within 30 days. The other 10 (83.3%) survived to the end of the 3-year study.

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ORIGINAL RESEARCH PAPER

  1. Birks, E. J. et al. Reversal of severe heart failure with a continous-flow left ventricular assist device and pharmacological therapy: a prospective study. Circulation 123, 381–390 (2011)

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  1. Paul J. Simpson
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Simpson, P. LVADs as a bridge to recovery. Nat Rev Cardiol 8, 120 (2011). https://doi.org/10.1038/nrcardio.2011.14

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