New hope for heart failure patients: a new chapter from "life support" to "myocardial recovery"

According to the latest data from the World Health Organization, about 2% of the world's adult population suffers from heart failure , and this proportion is rising with the aging of the population and changes in lifestyles.

Against this background, the rise of heart transplantation and ventricular assist devices (VAD) has brought new hope to patients with heart failure, not only improving their quality of life but also providing the possibility of prolonging their lives.

At the forefront of heart disease treatment, the application of VAD has successfully changed the fate of countless heart failure patients. As a mechanical pump, it can simulate the pumping function of the heart and provide necessary blood circulation support for patients with weak heart or heart failure. The left ventricular assist device (LVAD) is specially designed to assist or completely replace the pumping function of the left ventricle, which is particularly critical for patients with left ventricular failure. LVAD extracts blood from the left ventricle or left atrium and effectively pumps it into the aorta, thereby maintaining the patient's vital signs and blood circulation, providing patients with a new way of life support.

LVAD: From "life support" to "myocardial recovery"

With the advancement of technology, doctors have found that with the support of LVAD, the heart function of some patients can be significantly improved, even to the point where the device can be removed. In 2014, a team from the Department of Cardiothoracic Surgery at the University of Utah School of Medicine proposed a revolutionary concept: that LVAD should be transformed from a bridge to transplantation to support myocardial recovery and ultimately achieve the removal of the device.

This means that LVAD has changed from its original role of "life support" to an advanced treatment method that can promote the recovery of patients' heart function. In a 2021 study, Michael Dandel and other scholars further explored how to safely reduce VAD support after heart function is restored, and analyzed the performance of different types of VADs (such as left ventricular assist devices LVAD, right ventricular assist devices RVAD or biventricular assist devices) during the evacuation process. These studies have brought new hope to patients with heart failure and pointed out the direction for the development of VAD technology.

Milestone of medical innovation: China's first successful LVAD evacuation

In September 2023, a cardiac surgery team led by Professor Wang Chunsheng of Zhongshan Hospital affiliated to Fudan University successfully removed a patient's left ventricular assist device for the first time in China through percutaneous vascular plug implantation. The success of this operation not only attracted widespread attention in the medical community, but also marked an important step forward for China in the field of cardiac assist technology.

Image from Professor Wang Chunsheng's team

According to Wang Chunsheng's team, after receiving the Shenzhen Core Corheart® 6 LVAD implant, the patient's heart function improved significantly after careful treatment and monitoring. Under the strict evaluation of the medical team, the patient successfully underwent an interventional pump removal surgery, which means he will no longer rely on machine assistance and can resume normal life.

Image from Professor Wang Chunsheng's team

Cases of LVAD evacuation in the United States and their implications

A recent study published in the Journal of the American College of Cardiology: Heart Failure used the United Network for Organ Sharing (UNOS) database to track cases of LVAD implantation and subsequent removal due to myocardial recovery in the United States between 2005 and 2020.

The results of the study suggest that LVAD weaning for myocardial recovery is underutilized in the United States. Among 15,728 LVAD implants, 126 patients were successfully weaned from the LVAD for myocardial recovery.

The figure shows the cumulative incidence of death, heart transplantation, LVAD removal, and continued waiting for transplantation after LVAD implantation.

"More than half of the patients showed sustained myocardial recovery during a follow-up period of up to 4 years, and 70% did not experience recurrent heart failure. These data further demonstrate the potential of LVADs to support myocardial recovery."

Although 6% of patients experienced recurrent heart failure in the early period after evacuation (within 30 days), this rate gradually decreased thereafter.

This study not only provides valuable data on the long-term outcomes of myocardial recovery after LVAD removal, but also explores the relationship between different LVAD device types and myocardial recovery. The study found that the HeartMate II LVAD is more conducive to myocardial recovery than the HeartWare or HeartMate 3.

The authors conclude that "current LVAD weaning strategies are inadequately implemented in U.S. medical practice. This strategy has the potential to extend net life expectancy in patients with advanced heart failure, especially in younger patients with nonischemic etiologies. LVAD weaning should be considered a realistic option in the lifelong management of these patients."

Future Application Prospects of LVAD Technology

The above-mentioned related research results, including the successful implementation of the first LVAD withdrawal surgery in China, all demonstrate the great potential of LVAD technology in the treatment of heart failure. It not only plays a key role in long-term life support , but also shows its unique value in the withdrawal treatment after myocardial recovery .

As LVAD technology matures and costs decrease, it will bring new hope to more heart failure patients, helping them improve their quality of life and prolong their lives. With the continuous advancement of technology, LVAD will undoubtedly become an important direction for the treatment of heart disease in the future.

References

[1].Itagaki S, Moss N, Toyoda N, Mancini D, Egorova N, Serrao G, Lala A, Pinney SP, Boateng P, Adams DH, Anyanwu AC. Incidence, Outcomes, and Opportunity for Left Ventricular Assist Device Weaning for Myocardial Recovery. JACC Heart Fail. 2024 Jan 9:S2213-1779(23)00841-7. doi: 10.1016/j.jchf.2023.12.006. Epub ahead of print. PMID: 38276935.

[2]. Selzman CH, Madden JL, Healy AH, McKellar SH, Koliopoulou A, Stehlik J, Drakos SG. Bridge to removal: a paradigm shift for left ventricular assist device therapy. Ann Thorac Surg. 2015 Jan;99(1):360-7. doi: 10.1016/j.athoracsur.2014.07.061. Epub 2014 Nov 14. PMID: 25442985; PMCID: PMC4283551.

[3].Dandel M, Javier MFDM, Javier Delmo EM, Loebe M, Hetzer R. Weaning from ventricular assist device support after recovery from left ventricular failure with or without secondary right ventricular failure. Cardiovasc Diagn Ther. 2021 Feb;11(1):226-242. doi: 10.21037/cdt-20-288. PMID: 33708495; PMCID: PMC7944223.

[4]. The first case in China: The cardiac surgery team of Zhongshan Hospital affiliated to Fudan University completed the removal of the left ventricular assist device (LVAD) using percutaneous vascular plug implantation. Yandao Medical Voice Network. Published on: 2023-10-11 20:21:47

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Written by: Xiaoyu

Review: Shuxia

Layout: Chu Han