Myokarderholung unter mechanischer Ventrikelentlastung und Entwöhnung vom ventrikulären Unterstützungssystem View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2012-07-01

AUTHORS

M. Dandel, E. Potapov, T. Krabatsch, Y. Weng, C. Knosalla, R. Hetzer

ABSTRACT

Mechanical circulatory support for end-stage heart failure (HF) is a life-saving procedure which will later become either a bridge-to-transplantation or definitive therapy for patients with contraindications for transplantation. However, end-stage failing hearts have often shown remarkable ability to recover at the cellular and structural levels and there is also increasing evidence that, in some patients, initial bridge-to-transplantation can turn into bridge-to-myocardial recovery. It has been observed that during ventricular unloading there is high a probability of improvement in cardiac histology and myocardial contractile properties, restoration of adrenergic receptor density and responsiveness, and also improvement in calcium handling. Unfortunately, translation of these changes into functional recovery at the organ level is less frequent and stable cardiac improvement which might allow long-term transplant-free outcome after ventricular assist device (VAD) removal occurs only in relatively few patients. Detection of cardiac recovery which allows long-term cardiac stability after VAD removal is a major goal because it has been shown that weaning from VADs is a feasible clinical option with potentially successful results for more than 15 years even in patients with incomplete cardiac recovery during VAD support. This update focuses on the current development status of knowledge on unloading-promoted myocardial recovery, on its assessment in clinical practice, and on decision making in favor or against weaning from the VAD in patients with relevant cardiac improvement. More... »

PAGES

374-382

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00398-012-0939-1

DOI

http://dx.doi.org/10.1007/s00398-012-0939-1

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1002806772


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