Left ventricular assist device and drug therapy for the reversal of heart failure.

摘要: Background In patients with severe heart failure, prolonged unloading of the myocardium use a left ventricular assist device has been reported to lead myocardial recovery in small numbers for varying periods time. Increasing frequency and durability could reduce or postpone need subsequent transplantation. Methods We enrolled 15 failure due nonischemic cardiomyopathy no histologic evidence active myocarditis. All had markedly reduced cardiac output were receiving inotropes. The underwent implantation devices treated lisinopril, carvedilol, spironolactone, losartan enhance reverse remodeling. Once regression enlargement achieved, β 2 -adrenergic–receptor agonist clenbuterol was administered prevent atrophy. Results Eleven sufficient undergo explantation mean (±SD) 320±186 days after device. One patient died intractable arrhythmias 24 hours explantation; another carcinoma lung 27 months explantation. cumulative rate freedom from recurrent among surviving 100% 88.9% 1 4 years explantation, respectively. quality life as assessed by Minnesota Living Heart Failure Questionnaire score at 3 nearly normal. Fifty-nine ejection fraction 64±12%, end-diastolic diameter 59.4±12.1 mm, end-systolic 42.5±13.2 maximal oxygen uptake exercise 26.3±6.0 ml per kilogram body weight minute. Conclusions this single-center study, we found that sustained reversal secondary be achieved selected specific pharmacologic regimen.