Last update:
07-Jul-2004

The increasing prevalence and poor prognosis of end-stage heart failure in combination with the restricted availability of donor organs necessitate the development of alternative therapeutic strategies. During the past few years, mechanical circulatory support has been widely accepted as alternative treatment for patients with severe cardiac failure. A wide range of devices are available in clinical practice, offering various levels of cardiac support, including the total artificial heart and left ventricular assist devices. Mechanical blood pumps are currently being used as a “bridge to transplantation”, as a “bridge to recovery” and for permanent support of the failing myocardium. Recent studies suggest that long-term support with a left ventricular assist device might lead to normalization of myocardial structure and function, at the cellular level, and reverse the deteriorating natural course of heart failure. In molecular terms, this process has been defined as reverse remodeling. The exact mechanism underlying this recovery is unknown. Although the future direction of mechanical circulatory support has not been clearly specified, further research will pave the way for the establishment of novel therapeutic options which not only prevent the progression of cardiac failure but also reverse the heart failure phenotype.

Key words: Heart failure, Mechanical circulatory support, Remodeling, Total artificial heart, Ventricular assist devices.