Myocardial recovery following LVAD support

The use of left ventricular assist devices (LVADs) has been increasing in patients with end-stage heart failure in order to bridge them to transplantation and these devices are now also being used as "destination therapy". Some of these patients have demonstrated signs of recovery of the native heart and this recovery has been sufficient in some cases to allow explantation of the device and hence a new concept of bridge-to-recovery has been described. The rate of successful recovery leading to device explantation, however, has been only 5%–24% until recently when we showed it to be possible to increase the frequency and durability of myocardial recovery using drug therapy combined with LVAD unloading. This chapter summarises different types of LVADs and describes the clinical implications of myocardial recovery following device implantation, monitoring of myocardial recovery and gives the up-to-date findings of the histological and molecular changes in recovery.