Original Article
Left Ventricular Assist Device and Drug Therapy for the Reversal of Heart Failure
N Engl J Med 2006; 355:1873-1884November 2, 2006
- Abstract
Background
In patients with severe heart failure, prolonged unloading of the myocardium with the use of a left ventricular assist device has been reported to lead to myocardial recovery in small numbers of patients for varying periods of time. Increasing the frequency and durability of myocardial recovery could reduce or postpone the need for subsequent heart transplantation.
Methods
We enrolled 15 patients with severe heart failure due to nonischemic cardiomyopathy and with no histologic evidence of active myocarditis. All had markedly reduced cardiac output and were receiving inotropes. The patients underwent implantation of left ventricular assist devices and were treated with lisinopril, carvedilol, spironolactone, and losartan to enhance reverse remodeling. Once regression of left ventricular enlargement had been achieved, the β2-adrenergic–receptor agonist clenbuterol was administered to prevent myocardial atrophy.
Results
Eleven of the 15 patients had sufficient myocardial recovery to undergo explantation of the left ventricular assist device a mean (±SD) of 320±186 days after implantation of the device. One patient died of intractable arrhythmias 24 hours after explantation; another died of carcinoma of the lung 27 months after explantation. The cumulative rate of freedom from recurrent heart failure among the surviving patients was 100% and 88.9% 1 and 4 years after explantation, respectively. The quality of life as assessed by the Minnesota Living with Heart Failure Questionnaire score at 3 years was nearly normal. Fifty-nine months after explantation, the mean left ventricular ejection fraction was 64±12%, the mean left ventricular end-diastolic diameter was 59.4±12.1 mm, the mean left ventricular end-systolic diameter was 42.5±13.2 mm, and the mean maximal oxygen uptake with exercise was 26.3±6.0 ml per kilogram of body weight per minute.
Conclusions
In this single-center study, we found that sustained reversal of severe heart failure secondary to nonischemic cardiomyopathy could be achieved in selected patients with the use of a left ventricular assist device and a specific pharmacologic regimen.
Media in This Article
Figure 1
Ejection Fraction (Panel A), Left Ventricular End-Diastolic Diameter (Panel B), and Left Ventricular End-Systolic Diameter (Panel C) before Implantation and after Explantation, and Maximal Oxygen Consumption (VO2 Max) (Panel D) with Exercise before and after Explantation.Figure 2
Cumulative Rate of Freedom from Recurrence of Heart Failure among the 11 Surviving Patients Who Underwent Explantation.Article Activity
- Article
Heart failure is a major cause of death and disability in both developed and developing countries.1,2 The molecular, cellular, biochemical, and structural changes occurring in the myocardium, often referred to as remodeling, have been studied extensively in patients with heart failure.3-8 One intriguing feature of remodeling is that at least some of its manifestations can occasionally be reversed.5,9 There is now compelling evidence that prolonged, near-complete unloading of the left ventricle with the use of a left ventricular assist device (a mechanical pump) is associated with structural reverse remodeling10 that can be accompanied by functional improvement.11-13 However, recovery that is sufficient to permit explantation of the device has been observed in only 5 to 24% of patients in various series,14-19 with a relatively high incidence of early recurrence.17
To try to increase the incidence and durability of recovery, we have developed a form of combination therapy that consists of a HeartMate left ventricular assist device (Thoratec) and drugs known to enhance reverse remodeling, followed by the use of the β2-adrenergic–receptor agonist clenbuterol (approved for clinical use in humans in the United Kingdom, Canada, and some European countries but not in the United States). The rationale for this form of therapy has been described previously.7 We conducted a prospective study of this combination therapy.
Methods
Patients
The study population consisted of patients who received a HeartMate left ventricular assist device at Harefield Hospital, Harefield, United Kingdom, for nonischemic cardiomyopathy, in the absence of histologic evidence of acute myocarditis, and who became clinically stable 4 or more weeks after insertion of the device. The indication for insertion of the left ventricular assist device was the development of severe heart failure that was not responsive to intensive medical treatment, including inotropic support, with evidence of impending or actual multiorgan failure due to low cardiac output. The study was approved by the ethics committee of the Royal Brompton and Harefield National Health Service Trust. All patients provided written informed consent.
Pharmacologic Therapy
Pharmacologic management consisted of two stages. In the first stage (intended to enhance reverse remodeling), treatment with four drugs was initiated immediately after the patient had been weaned from inotropic therapy with adequate end-organ recovery. The four drugs and the maximum titrated doses were as follows: lisinopril, 40 mg daily; carvedilol, 50 mg twice daily; spironolactone, 25 mg daily; and losartan, 100 mg daily.
The second stage of pharmacologic therapy was instituted after maximal regression in the left ventricular end-diastolic diameter had been achieved while the left ventricular assist device was in place. When a constant left ventricular size had been maintained for at least 2 weeks, according to echocardiographic assessment, clenbuterol was administered at an initial dose of 40 μg twice daily, then at a dose of 40 μg three times daily, and finally at a dose of 700 μg three times daily. The dose was adjusted to maintain the resting heart rate at a level below 100 beats per minute. Before clenbuterol was started, carvedilol was replaced by the selective β1-blocker bisoprolol.
Monitoring of Recovery
Echocardiography was performed before implantation and then weekly after implantation for the first month, every 2 weeks for 6 months, and monthly thereafter. During the first month, measurements were obtained when the left ventricular assist device was on. After week 4, measurements were obtained both when the device was on and when it was off (after the administration of 10,000 IU of heparin and hand-pumping three times every 15 seconds to prevent blood stagnation inside the pump) at 5 and 15 minutes. We measured the left ventricular diameter during systole and diastole, the ejection fraction (according to the ellipse formula for single-plane volume determination), and the left atrial diameter. The inflow valve of the left ventricular assist device was also assessed for evidence of regurgitation.
If the left ventricular assist device could be stopped for 20 minutes with no ill effects, a 6-minute walking test was performed, with repeated echocardiographic measurements to determine inotropic reserve. Once the patients were able to walk 450 m in 6 minutes while the device was off, with no deterioration of the echocardiographic measurements, cardiopulmonary exercise tests were performed monthly with the device on and with it off.
Cardiac catheterization was performed before implantation, before the start of clenbuterol therapy, and before explantation. Right-sided and left-sided pressures and cardiac output were measured (with the device on and then off for 15 minutes), and a left ventriculogram was obtained (with the device off).
Explantation and Follow-up
Explantation was considered if the following criteria were met while the left ventricular assist device was off for 15 minutes: a left ventricular end-diastolic diameter of less than 60 mm, a left ventricular end-systolic diameter of less than 50 mm, and a left ventricular ejection fraction (LVEF) of more than 45%; a left ventricular end-diastolic pressure (or pulmonary-capillary wedge pressure) of less than 12 mm Hg; a resting cardiac index of more than 2.8 liters per minute per square meter of body-surface area; and maximal oxygen consumption (VO2 max) with exercise of more than 16 ml per kilogram of body weight per minute and an increase in minute ventilation (VE) relative to the production of carbon dioxide (VCO2) (VE/VCO2 slope) of less than 34.
The device was explanted by means of a minimally invasive technique20 in all patients except one who had an abscess around the device that extended around the outflow graft. Lisinopril, spironolactone, and losartan were restarted after explantation, but clenbuterol was discontinued. Carvedilol was restarted in place of bisoprolol.
All patients were assessed at our center at monthly intervals with echocardiography, cardiopulmonary exercise tests, and a determination of brain natriuretic peptide concentrations. Catheterization of the right and left heart was performed 3 months and 1 year after explantation. Quality of life was assessed 3 years after explantation according to the score on the Minnesota Living with Heart Failure Questionnaire.21
Statistical Analysis
Values are expressed as means ±SD. Values before implantation and before explantation of the left ventricular assist device were compared with the use of the Wilcoxon signed-rank test (SAS software, release 8.02). A nonparametric rank-sum test was used to assess the effects of age, left ventricular dimensions, and duration of heart failure on recovery.
Results
Characteristics of the Study Population
Between December 1999 and July 2001, a total of 27 patients underwent insertion of ventricular assist devices at Harefield Hospital. All patients had severe heart failure with evidence of organ dysfunction due to low cardiac output. The bilirubin level was elevated (indicative of hepatic dysfunction) in all patients, and the urinary output was less than 0.5 ml per kilogram per hour despite adequate filling and the use of inotropes (indicative of renal dysfunction) in 20. Of these 27 patients, 3 were excluded from the study because they had ischemic cardiomyopathy.
Of the 24 patients with nonischemic cardiomyopathy, 4 underwent implantation of the device as salvage therapy on compassionate grounds and were excluded from the study. These four patients were in cardiogenic shock while receiving very large doses of at least four inotropes, with combined renal and hepatic failure; three of them had gross acidosis, three required an intraaortic balloon pump, and one required extracorporeal membrane oxygenation. An additional five patients were considered to be potential candidates for the study at the time of implantation of the device but did not complete the course of pharmacologic therapy. Four of these patients died in the perioperative period, and severe abdominal complications developed in one on the eighth perioperative day; he died of disseminated sepsis 138 days after implantation of the left ventricular device, having received low doses of the stage 1 drugs but no stage 2 therapy.
The remaining 15 patients were enrolled in the study and received the combination therapy. The demographic characteristics, diagnoses, duration of heart failure, and care of these patients are shown in Table 1Table 1
Preimplantation Characteristics of the Patients., as are echocardiographic and hemodynamic measurements. Histologic evaluation of tissue obtained during implantation of the device in the 15 patients showed interstitial and replacement fibrosis, with myocyte hypertrophy, nuclear enlargement, and occasional vacuolated myocytes, features that are compatible with dilated cardiomyopathy. Conventional light microscopy showed no lymphocytic myocarditis, but occasional foci of mixed chronic inflammation surrounding damaged myocytes were noted, suggesting inotrope-related myocardial damage.During the second stage of pharmacologic therapy, when the administration of clenbuterol was begun, a mild tremor developed in most of the study patients, muscle cramps in four, and diaphoresis in one. No new arrhythmias occurred, although there was a clinically significant increase in the heart rate, as would be expected with a β-adrenergic agonist. Serial measurements of cardiac enzymes were not performed, but serum creatine kinase levels were not elevated in the patients in whom muscle cramps developed. No other side effects were noted.
Frequency and Characteristics of Recovery
Of the 15 patients who received a complete course of the combination therapy, 11 (73%) had sufficient recovery to meet the explantation criteria (Table 2Table 2
Postimplantation Events in the Study Patients.). This number represents 46% of all 24 patients who received a left ventricular assist device for nonischemic cardiomyopathy (including those who did not survive the perioperative period and those who received a device on compassionate grounds). For patients undergoing explantation, the mean duration of support with a left ventricular assist device was 320±186 days (range, 63 to 603). In one patient, explantation was required because of device failure. In three patients, severe infection was present at the time of explantation.The mean LVEF (with the pump off for 15 minutes) was 64±8% before explantation as compared with 12±6% before implantation (P=0.001), the mean left ventricular end-diastolic diameter was 55.9±8.3 mm as compared with 75.1±16.3 mm (P=0.002), and the mean left ventricular end-systolic diameter was 39.6±6.5 mm as compared with 66.9±16.3 mm (P=0.002). Before explantation, the mean walking distance in 6 minutes (with the pump off) was 632±231 m, and the mean VO2 max (with the pump off) was 20.7±6.1 ml per kilogram per minute, with a mean VE/VCO2 slope of 32.5±7.9. Cardiac catheterization before explantation (with the pump off) showed a mean right atrial pressure of 5.6±3.4 mm Hg, a pulmonary-capillary wedge pressure of 9.0±4.1 mm Hg (as compared with 23.8±9.7 mm Hg during inotropic therapy before implantation, P=0.004), a cardiac output of 5.4±1.2 liters per minute, a cardiac index of 2.8±0.7 liters per minute per square meter, and a pulmonary-artery oxygen saturation of 66.9±4.8%.
Four patients underwent heart transplantation after completing the full course of combination therapy (Table 2). Transplantation was performed because of lack of myocardial recovery in three patients and the development of appreciable mitral, tricuspid, and aortic regurgitation in one. Although the numbers were too small for meaningful analysis, we found no evidence that age, left ventricular dimensions, or the duration of heart failure was a determinant of recovery. Of five patients with a left ventricular end-diastolic diameter of more than 80 mm, four recovered.
Clinical Course and Survival
No patient died during the course of combination therapy. The actuarial survival rate 1 and 4 years after explantation was 90.9% and 81.8%, respectively. One patient died of intractable arrhythmia 24 hours after explantation, without evidence of deteriorating ventricular function, and another died of carcinoma of the lung 27 months after explantation. Of the four patients who underwent transplantation because they did not qualify for explantation, one died of primary graft failure in the perioperative period.
The minimum period of follow-up after explantation was approximately 4 years (range, 1519 to 2058 days; mean, 1799±153 days [59±5 months]). All surviving patients continued to be in New York Heart Association class I except one, in whom severe heart failure recurred, with progressive left ventricular dilatation and reduction of the ejection fraction (Figure 1Figure 1
Ejection Fraction (Panel A), Left Ventricular End-Diastolic Diameter (Panel B), and Left Ventricular End-Systolic Diameter (Panel C) before Implantation and after Explantation, and Maximal Oxygen Consumption (VO2 Max) (Panel D) with Exercise before and after Explantation.), after an episode of heavy alcohol consumption 21 months after explantation. He underwent successful transplantation 33 months after explantation. Among the surviving patients, the cumulative rate of freedom from recurrence of heart failure 1 and 4 years after explantation was 100% and 88.9%, respectively (Figure 2Figure 2Cumulative Rate of Freedom from Recurrence of Heart Failure among the 11 Surviving Patients Who Underwent Explantation.).The mean score on the Minnesota Living with Heart Failure Questionnaire (scores can range from 0 to 105, with higher scores indicating a worse quality of life) was 12.1±11.7 3 years after explantation. Of the eight patients surviving without a heart transplant, four are working, two are retired and lead very active lives, one is a mother looking after two children, and one does not work despite a normal exercise capacity.
Echocardiographic and Laboratory Data
Figure 1 shows the LVEF, end-diastolic diameter, and end-systolic diameter over time after the left ventricular device had been explanted. At a mean follow-up of 59±5 months, the mean LVEF was 64±12%, the mean left ventricular end-diastolic diameter was 59.4±12.1 mm, the mean left ventricular end-systolic diameter was 42.5±13.2 mm, and the mean VO2 max was 26.3±6.0 ml per kilogram per minute. An asymptomatic decline in the ejection fraction to 30% occurred in one patient 45 months after explantation (Figure 1). He underwent implantation of a biventricular pacemaker, with a subsequent increase in his ejection fraction to 45%.
The changes in brain natriuretic peptide levels in the patients who underwent explantation are shown in Figure 3Figure 3
Brain Natriuretic Peptide (BNP) Levels in 11 Patients before and after Implantation and Explantation.. The mean plasma level fell from 113.4±107.0 pmol per liter before implantation to 5.7±4.8 pmol per liter before explantation, 7.5±8.7 pmol per liter at 12 months, and 19.1±19.4 pmol per liter at 48 months.Hemodynamic Values
Among the patients whose devices were successfully explanted, mean hemodynamic values 3 months after explantation were as follows: right atrial pressure, 6.2±2.1 mm Hg; pulmonary-capillary wedge pressure, 12.8±6.9 mm Hg; left ventricular end-diastolic pressure, 12.9±5.9 mm Hg; cardiac output, 4.9±2.1 liters per minute; cardiac index, 2.4±1.0 liters per minute per square meter; and pulmonary-artery oxygen saturation, 69.8±29.9% (10 patients). One year after explantation, mean values were as follows: right atrial pressure, 5.1±3.3 mm Hg; pulmonary-capillary wedge pressure, 9.5±6.2 mm Hg; left ventricular end-diastolic pressure, 9.3±5.5 mm Hg; cardiac output, 4.9±2.1 liters per minute; cardiac index, 2.4±1.2 liters per minute per square meter; and pulmonary-artery oxygen saturation, 73.5±32% (eight patients).
Discussion
We found that severe heart failure secondary to nonischemic cardiomyopathy can be reversed in selected patients without acute myocarditis with the use of a specific sequence of mechanical and pharmacologic therapy.7 Significant clinical improvement in these patients was associated with improvement in hemodynamics, exercise capacity, and quality of life, along with marked functional changes in the myocardium. Improvement was maintained for more than 4 years in most patients. Quality of life among the patients who underwent successful explantation compared favorably with that among patients with long-term implantation of ventricular assist devices.21
In our study, approximately 75% of the patients who received a full course of the combination therapy recovered. The overall rate of recovery among all patients with nonischemic cardiomyopathy who underwent implantation of a left ventricular assist device during this period was 46% at our institution, which may represent an underestimate of the benefit of the combination therapy, since this percentage includes patients who were excluded from the study group, who were not treated with a full course of the study regimen, or both. The rate and duration of recovery in our series were significantly higher than previously reported after implantation of left ventricular assist devices.14,17-19 The rates in previously published studies were 5%,14 24%,17 and 11% in a larger series18 that included patients with acute myocarditis. The cumulative rate of freedom from recurrence of heart failure in our series was 88.9% at 4 years. The single patient in our series whose condition worsened may have had an additional myocardial insult due to alcohol abuse.
The objective of the initial phase of mechanical and pharmacologic therapy is to reverse ventricular remodeling. Mechanical support with a left ventricular assist device has been shown to lead to a reduction in neuroendocrine activation22 and myocyte hypertrophy.10 Extensive data from clinical trials show that beta-blockers, angiotensin converting–enzyme inhibitors, angiotensin II–receptor blockers, and aldosterone antagonists can all reduce left ventricular remodeling.23-26
The benefit of the second stage of pharmacologic therapy is less firmly established. However, several lines of evidence suggest that selective stimulation of β2-adrenergic receptors may be beneficial in the setting of heart failure. The highly selective β2-antagonist ICI 118,551 inhibits contraction of isolated myocytes from patients with severe heart failure by 45% as compared with 5% for myocytes from persons without heart failure,27 and adenovirus-mediated overexpression of β2-adrenergic receptors results in improved ventricular function28 and functional recovery of unloaded heart failure in a rabbit model.29 Recently, β2-agonists have been shown to have a beneficial effect on left ventricular remodeling after myocardial infarction in a rat model.30 Furthermore, stimulation of cardiac myocytes with β2-agonists seems to provide protection against apoptosis.31
The selective β2-agonist clenbuterol, currently approved in the United Kingdom for the treatment of asthma, has beneficial effects on excitation–contraction coupling and myocardial metabolism in experimental models.32,33 In addition, clenbuterol has been found to cause mild myocardial hypertrophy.34 Such hypertrophy may actually confer a physiological benefit, because studies of myocardial tissue during long-term use of left ventricular assist devices suggest that myocyte atrophy may occur in response to long-term mechanical unloading10,35,36; this effect may be prevented or reversed by clenbuterol. The use of β2 adrenergic receptor–agonists has also been shown to increase skeletal muscle strength in normal volunteers37 and in a small number of patients with muscle weakness due to some forms of myopathy or neurogenic causes.38
The potential benefits of clenbuterol in cases of heart failure should be interpreted with caution, because adverse effects of this agent on the myocardium and the skeletal muscle have also been reported in animal models. Apoptosis and necrosis of myocytes have been reported,39,40 particularly when the drug is given without beta1-blockade.41 In our study the only adverse effects were mild tremor and muscle cramps. No serious side effects were observed.
Limitations of this study include the relatively small number of patients and the lack of a control group. In addition, the combination therapy used in this protocol did not allow for evaluation of the specific role of each drug used. These issues, as well as the question of which clinical characteristics are predictive of recovery, will need to be evaluated in future studies.
In this study we included two patients with factors that might have influenced their chance of recovery. One patient had received anthracycline, which may render recovery less likely, and one had a peripartum cardiomyopathy, which is associated with a greater chance of spontaneous recovery than is expected in patients with idiopathic cardiomyopathy (although when these patients have persistently abnormal ventricular function, they face the same relatively poor prognosis as patients with dilated cardiomyopathy from any cause42). Cardiac dilatation was present in all patients except one, who had a normal-sized heart in the presence of severe systolic and diastolic dysfunction. This patient had no histologic evidence of myocarditis, with negative results of polymerase-chain-reaction testing for enterovirus (coxsackievirus), adenovirus, parvovirus, and Epstein–Barr virus, although myocarditis can be patchy.
In conclusion, we found that sustained reversal of severe heart failure secondary to nonischemic cardiomyopathy could be achieved in selected patients. Our regimen of mechanical and pharmacologic therapy may enhance the frequency and durability of myocardial recovery as compared with other therapeutic approaches, although a direct comparison of treatment protocols was not performed. The reproducibility and durability of these findings, as well as the mechanisms contributing to the findings, require further study in different groups of patients.
Supported by grants from Thoratec, the Royal Brompton and Harefield Charitable Trustees, the British Heart Foundation, and the Magdi Yacoub Institute.
Dr. Yacoub reports having received an educational grant from Thoratec for the support of the Harefield Heart Science Centre and the Royal Brompton and Harefield NHS Trust. No other potential conflict of interest relevant to this article was reported.
We thank Carole Webb for her assistance with echocardiography, Mandy Hipkin for her hard work and dedication to the left ventricular assist device program, James Hooper for performing the analysis of brain natriuretic peptide, and Derek Robinson for performing the statistical analysis.
Source Information
From the Royal Brompton and Harefield National Health Service Trust, Harefield, Middlesex, United Kingdom (E.J.B., P.D.T., J.H., R.S.G., C.T.B., M.B., N.R.B., A.K., M.H.Y.); and the Heart Science Centre, National Heart and Lung Institute, Imperial College, London (E.J.B., P.D.T., J.H., R.S.G., C.T.B., A.K., M.H.Y.).
Address reprint requests to Dr. Yacoub at the Heart Science Centre, Royal Brompton and Harefield Hospital, Harefield, Middlesex UB9 6JH, United Kingdom, or at m.yacoub@ic.ac.uk.
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Citing Articles
1
Craig R. Butler, Bodh I. Jugdutt. (2012) The paradox of left ventricular assist device unloading and myocardial recovery in end-stage dilated cardiomyopathy: implications for heart failure in the elderly. Heart Failure Reviews
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O. Wever-Pinzon, J. Stehlik, A.G. Kfoury, J.V. Terrovitis, N.A. Diakos, C. Charitos, D.Y. Li, S.G. Drakos. (2012) Ventricular assist devices: Pharmacological aspects of a mechanical therapy. Pharmacology & Therapeutics
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Tomoko S. Kato, P. Christian Schulze, Jonathan Yang, Ernest Chan, Khurram Shahzad, Hiroo Takayama, Nir Uriel, Ulrich Jorde, Maryjane Farr, Yoshifumi Naka, Donna Mancini. (2012) Pre-operative and post-operative risk factors associated with neurologic complications in patients with advanced heart failure supported by a left ventricular assist device. The Journal of Heart and Lung Transplantation 31:1, 1-8
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Tomoko S. Kato, Aalap Chokshi, Parvati Singh, Tuba Khawaja, Shinichi Iwata, Shunichi Homma, Hirokazu Akashi, Faisal Cheema, Jonathan Yang, Hiroo Takayama, Yoshifumi Naka, Maryjane Farr, Donna Mancini, P. Christian Schulze. (2012) Markers of extracellular matrix turnover and the development of right ventricular failure after ventricular assist device implantation in patients with advanced heart failure. The Journal of Heart and Lung Transplantation 31:1, 37-45
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Matthew L. Stone, Ahmet Kilic, Jamie L.W. Kennedy, James D. Bergin, John A. Kern. (2012) The Cohn Felt Plug: An Effective HeartMate II® Reimplantation Technique. Journal of Cardiac Surgery 27:1, 122-124
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Daniel J. Cantillon, Christopher Bianco, Oussama O. Wazni, Mohamed Kanj, Nicholas G. Smedira, Bruce L. Wilkoff, Randall C. Starling, Walid I. Saliba. (2012) Electrophysiologic Characteristics and Catheter Ablation of Ventricular Tachyarrhythmias Among Heart Failure Patients on Ventricular Assist Device Support. Heart Rhythm
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Norimichi Koitabashi, David A. Kass. (2011) Reverse remodeling in heart failure—mechanisms and therapeutic opportunities. Nature Reviews Cardiology
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S J Park, S S Kushwaha, C G A McGregor. (2011) State-of-the-Art Implantable Cardiac Assist Device Therapy for Heart Failure: Bridge to Transplant and Destination Therapy. Clinical Pharmacology & Therapeutics
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Sherief Mansour, Amr Youssef, Mona Rayan, M. Ayman Saleh. (2011) Efficacy of ivabradine in idiopathic dilated cardiomyopathy patients with chronic heart failure. The Egyptian Heart Journal
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Michael Ibrahim, Cesare M. Terracciano, Magdi H. Yacoub. (2011) Bridge to Recovery: What Remains to be Discovered?. Cardiology Clinics 29:4, 531-547
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Masato Koike, Hideto Kojima, Mineko Fujimiya, Keiji Matsubayashi, Yoshinari Aimi, Hiroshi Kimura, Tohru Asai. (2011) Transfer of Bone Marrow Progenitors Prevents Coronary Insufficiency and Systolic Dysfunction in the Mechanical Unloaded Heart in Mice. Journal of Surgical Research 171:1, 47-57
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Ming-Da Zhou, Chuan Yang, Zhiwen Liu, Joshua P. Cysyk, Si-Yang Zheng. (2011) An implantable Fabry-Pérot pressure sensor fabricated on left ventricular assist device for heart failure. Biomedical Microdevices
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Nicholas Richard Gaddum, Daniel Lee Timms, Michael Stevens, David Mason, Nigel Lovell, John F. Fraser. (2011) Comparison of Preload-Sensitive Pressure and Flow Controller Strategies for a Dual Device Biventricular Support System. Artificial Organsno-no
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T. Krabatsch, M. Schweiger, A. Stepanenko, T. Drews, E. Potapov, M. Pasic, Y. Weng, M. Huebler, R. Hetzer. (2011) Fortschritte bei implantierbaren mechanischen Kreislaufunterstüzungssystemen. Herz 36:7, 622-629
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Olga V. Savinova, A. Martin Gerdes. (2011) Myocyte Changes in Heart Failure. Heart Failure Clinics
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Christian Schlensak, David Schibilsky, Matthias Siepe, Kerstin Brehm, Rolf Klemm, Robert von Wattenwyl, Michael Berchthold-Herz, Christoph Benk, Friedhelm Beyersdorf. (2011) Biventricular cannulation is superior regarding hemodynamics and organ recovery in patients on biventricular assist device support. The Journal of Heart and Lung Transplantation 30:9, 1011-1017
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STAVROS DIMOPOULOS, NIKOLAOS DIAKOS, ELENI TSELIOU, ATHANASIOS TASOULIS, ANTHI MPOUCHLA, CHRISTOS MANETOS, LAMBROS KATSAROS, STAVROS DRAKOS, JOHN TERROVITIS, SERAFIM NANAS. (2011) Chronotropic Incompetence and Abnormal Heart Rate Recovery Early after Left Ventricular Assist Device Implantation. Pacing and Clinical Electrophysiologyno-no
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D. G. Jakovljevic, E. J. Birks, R. S. George, M. I. Trenell, P. M. Seferovic, M. H. Yacoub, D. A. Brodie. (2011) Relationship between peak cardiac pumping capability and selected exercise-derived prognostic indicators in patients treated with left ventricular assist devices. European Journal of Heart Failure 13:9, 992-999
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Chitaru Kurihara, Takashi Nishimura, Kan Nawata, Osamu Kinoshita, Motoyuki Hisagi, Noboru Motomura, Shunei Kyo, Minoru Ono. (2011) Successful bridge to recovery with VAD implantation for anthracycline-induced cardiomyopathy. Journal of Artificial Organs 14:3, 249-252
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Chetan B. Patel, Joseph G. Rogers. (2011) Durable Mechanical Circulatory Support Devices. Progress in Cardiovascular Diseases 54:2, 132-143
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Kyriakos Anastasiadis, Polychronis Antonitsis, Argirios Doumas, Georgios Koliakos, Helena Argiriadou, Christina Vaitsopoulou, Paschalis Tossios, Christos Papakonstantinou, Stephen Westaby. (2011) Stem cells transplantation combined with long-term mechanical circulatory support enhances myocardial viability in end-stage ischemic cardiomyopathy. International Journal of Cardiology
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Jesus Herreros, Juan Bustamante. (2011) Myocardial regeneration in heart failure: integrated development of biological therapeutic approaches. Expert Review of Cardiovascular Therapy 9:8, 1027-1039
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Shaun David Gregory, Daniel Timms, Nicholas Richard Gaddum, Charles McDonald, Mark John Pearcy, John F. Fraser. (2011) In Vitro Evaluation of a Compliant Inflow Cannula Reservoir to Reduce Suction Events With Extracorporeal Rotary Ventricular Assist Device Support. Artificial Organs 35:8, 765-772
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Didier Bresson, Franck Sibellas, Fadi Farhat, Olivier Jegaden, Gilbert Kirkorian, Eric Bonnefoy. (2011) Preliminary experience with Impella Recover® LP5.0 in nine patients with cardiogenic shock: A new circulatory support system in the intensive cardiac care unit. Archives of Cardiovascular Diseases 104:8-9, 458-464
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Hussein S. Al-Amri, Abdulrahman M. Al-Moghairi, Rieda M. El Oakley. (2011) Surgical treatment of functional mitral regurgitation in dilated cardiomyopathy. Journal of the Saudi Heart Association 23:3, 125-134
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Leanne Elizabeth Felkin, Enrique A. Lara-Pezzi, Jennifer L. Hall, Emma J. Birks, Paul J. R. Barton. (2011) Reverse Remodelling and Recovery from Heart Failure Are Associated with Complex Patterns of Gene Expression. Journal of Cardiovascular Translational Research 4:3, 321-331
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Thomas Krabatsch, Martin Schweiger, Alexander Stepanenko, Marian Kukucka, Juliane Vierecke, Hans B. Lehmkuhl, Michael Huebler, Ewald Hennig, Evgenij Potapov, Roland Hetzer. (2011) Mechanical Circulatory Support—Results, Developments and Trends. Journal of Cardiovascular Translational Research 4:3, 332-339
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Mickey Ising, Sean Warren, Michael A. Sobieski, Mark S. Slaughter, Steven C. Koenig, Guruprasad A. Giridharan. (2011) Flow Modulation Algorithms for Continuous Flow Left Ventricular Assist Devices to Increase Vascular Pulsatility: A Computer Simulation Study. Cardiovascular Engineering and Technology 2:2, 90-100
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M. Dandel, Y. Weng, H. Siniawski, A. Stepanenko, T. Krabatsch, E. Potapov, H. B. Lehmkuhl, C. Knosalla, R. Hetzer. (2011) Heart failure reversal by ventricular unloading in patients with chronic cardiomyopathy: criteria for weaning from ventricular assist devices. European Heart Journal 32:9, 1148-1160
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Ana Maria Segura, O.H. Frazier, Zumrut Demirozu, L. Maximilian Buja. (2011) Histopathologic correlates of myocardial improvement in patients supported by a left ventricular assist device. Cardiovascular Pathology 20:3, 139-145
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Chelsea L. Ihnat, Hannah Zimmerman, Jack G. Copeland, F. John Meaney, Richard E. Sobonya, Brandon T. Larsen, Brian Blair, Daniela Lax, Brent J. Barber. (2011) Left Ventricular Assist Device Support as a Bridge to Recovery in Young Children. Congenital Heart Disease 6:3, 234-240
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M. H. Yacoub, C. M. Terracciano. (2011) The Holy Grail of LVAD-induced reversal of severe chronic heart failure: the need for integration. European Heart Journal 32:9, 1052-1054
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Piera Morlacchi, Richard R. Nelson. (2011) How medical practice evolves: Learning to treat failing hearts with an implantable device. Research Policy 40:4, 511-525
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Stavros G Drakos, Abdallah G Kfoury, Craig H Selzman, Divya Ratan Verma, John N Nanas, Dean Y Li, Josef Stehlik. (2011) Left ventricular assist device unloading effects on myocardial structure and function: current status of the field and call for action. Current Opinion in Cardiology 26:3, 245-255
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Joseph C. Cleveland, David C. Naftel, T. Brett Reece, Margaret Murray, James Antaki, Francis D. Pagani, James K. Kirklin. (2011) Survival after biventricular assist device implantation: An analysis of the Interagency Registry for Mechanically Assisted Circulatory Support database. The Journal of Heart and Lung Transplantation
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Evgenij V. Potapov, Thomas Krabatsch, Hector O. Ventura, Roland Hetzer. (2011) Advances in mechanical circulatory support: Year in review. The Journal of Heart and Lung Transplantation 30:5, 487-493
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Joaquín Pérez-Schindler, Andrew Philp, Keith Baar, Jesús Hernández-Cascales. (2011) Regulation of contractility and metabolic signaling by the β2-adrenergic receptor in rat ventricular muscle. Life Sciences 88:19-20, 892-897
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Thomas Krabatsch, Martin Schweiger, Michael Dandel, Alexander Stepanenko, Thorsten Drews, Evgenij Potapov, Miralem Pasic, Yu-Guo Weng, Michael Huebler, Roland Hetzer. (2011) Is Bridge to Recovery More Likely With Pulsatile Left Ventricular Assist Devices Than With Nonpulsatile-Flow Systems?. The Annals of Thoracic Surgery 91:5, 1335-1340
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Ranjit John. (2011) Invited Commentary. The Annals of Thoracic Surgery 91:5, 1340-1341
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Ana Garcia-Alvarez, Leticia Fernandez-Friera, Joe F. Lau, Simonette T. Sawit, Jesus G. Mirelis, Javier G. Castillo, Sean Pinney, Anelechi C. Anyanwu, Valentin Fuster, Javier Sanz, Mario J. Garcia. (2011) Evaluation of right ventricular function and post-operative findings using cardiac computed tomography in patients with left ventricular assist devices. The Journal of Heart and Lung Transplantation
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Yoan Lamarche, Mark Kearns, Kiranbir Josan, Jamil Bashir, Andrew Ignaszewski, Annemarie Kaan, Jennifer Kealy, Robert Moss, Anson Cheung. (2011) Successful Weaning and Explantation of the Heartmate II Left Ventricular Assist Device. Canadian Journal of Cardiology 27:3, 358-362
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Masahiko Ando, Takashi Nishimura, Yoshiaki Takewa, Daisuke Ogawa, Kenji Yamazaki, Koichi Kashiwa, Shunei Kyo, Minoru Ono, Yoshiyuki Taenaka, Eisuke Tatsumi. (2011) What is the ideal off-test trial for continuous-flow ventricular-assist-device explantation? Intracircuit back-flow analysis in a mock circulation model. Journal of Artificial Organs 14:1, 70-73
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Stavros G. Drakos, John V. Terrovitis, John N. Nanas, Efstratios I. Charitos, Argirios S. Ntalianis, Konstantinos G. Malliaras, Nikolaos Diakos, Dimitrios Koudoumas, Stergios Theodoropoulos, Magdi H. Yacoub, Maria I. Anastasiou-Nana. (2011) Reverse Electrophysiologic Remodeling After Cardiac Mechanical Unloading for End-Stage Nonischemic Cardiomyopathy. The Annals of Thoracic Surgery 91:3, 764-769
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Masahiko Ando, Takashi Nishimura, Yoshiaki Takewa, Daisuke Ogawa, Kenji Yamazaki, Koichi Kashiwa, Shunei Kyo, Minoru Ono, Yoshiyuki Taenaka, Eisuke Tatsumi. (2011) A novel counterpulse drive mode of continuous-flow left ventricular assist devices can minimize intracircuit backward flow during pump weaning. Journal of Artificial Organs 14:1, 74-79
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Ravi Rasalingam, Stephanie N. Johnson, Kyle R. Bilhorn, Pei-Hsiu Huang, Majesh Makan, Nader Moazami, Julio E. Pérez. (2011) Transthoracic Echocardiographic Assessment of Continuous-Flow Left Ventricular Assist Devices. Journal of the American Society of Echocardiography 24:2, 135-148
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Jennifer L. Hall, David R. Fermin, Emma J. Birks, Paul J.R. Barton, Mark Slaughter, Peter Eckman, Hideo A. Baba, Jeremias Wohlschlaeger, Leslie W. Miller. (2011) Clinical, Molecular, and Genomic Changes in Response to a Left Ventricular Assist Device. Journal of the American College of Cardiology 57:6, 641-652
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Raffaele Caruso, Chiara Caselli, Chiara Boroni, Jonica Campolo, Filippo Milazzo, Manuela Cabiati, Claudio Russo, Marina Parolini, Daniela Giannessi, Maria Frigerio, Oberdan Parodi. (2011) Relationship Between Myocardial Redox State and Matrix Metalloproteinase Activity in Patients on Left Ventricular Assist Device Support. Circulation Journal 75:10, 2387-2396
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Lars H Lund, Karl-Henrik Grinnemo, Peter Svenarud, Jan van der Linden, Maria J Eriksson. (2011) Myocardial recovery in peri-partum cardiomyopathy after continuous flow left ventricular assist device. Journal of Cardiothoracic Surgery 6:1, 150
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Carlo R. Bartoli, Kenneth R. Brittian, Guruprasad A. Giridharan, Steven C. Koenig, Tariq Hamid, Sumanth D. Prabhu. (2011) Bovine Model of Doxorubicin-Induced Cardiomyopathy. Journal of Biomedicine and Biotechnology 2011, 1-11
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Masahiko Ando, Takashi Nishimura, Yoshiaki Takewa, Shunei Kyo, Minoru Ono, Yoshiyuki Taenaka, Eisuke Tatsumi. (2011) Creating an ideal “off-test mode” for rotary left ventricular assist devices: Establishing a safe and appropriate weaning protocol after myocardial recovery. Journal of Thoracic and Cardiovascular Surgery
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Guang-Liang Jiang, Yu-Dong Gu, Li-Yin Zhang, Li-Ying Shen, Cong Yu, Jian-Guang Xu. (2011) Randomized, Double-Blind, and Placebo-Controlled Trial of Clenbuterol in Denervated Muscle Atrophy. ISRN Pharmaceutics 2011, 1-7
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Pong-Jeu Lu, Pao-Yen Lin, Chi-Fu Jeffrey Yang, Chun-Hao Hung, Ming-Yao Chan, Tzu-Cheng Hsu. (2011) Hemodynamic and Metabolic Effects of Para- versus Intraaortic Counterpulsatile Circulation Supports. ASAIO Journal 57:1, 19-25
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Shigeru Miyagawa, Matthias Roth, Atsuhiro Saito, Yoshiki Sawa, Sawa Kostin. (2011) Tissue-Engineered Cardiac Constructs for Cardiac Repair. The Annals of Thoracic Surgery 91:1, 320-329
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Cherissa Hanson, Keith C. Kocis, Ana Lía Graciano. 2011. Myocardial Dysfunction, Ventricular Assist Devices, and Extracorporeal Life Support. , 319-337.
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Chetan B. Patel, Kevin M. Alexander, Joseph G. Rogers. (2010) Mechanical Circulatory Support for Advanced Heart Failure. Current Treatment Options in Cardiovascular Medicine 12:6, 549-565
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Yukihiko Nosé, Tadashi Motomura, Hiroshi Miyamoto, Kazuhide Ohta, Junji Takaba, Yoichi Sugita. (2010) The Need to Change Our Objective for Artificial Heart Development: From Totally Implantable Permanent Ventricular Assist Devices to Wearable Therapeutic Ventricular Assist Devices. Artificial Organs 34:12, 1069-1076
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Philip Formica, Sandhya Murthy, Pauline Edwards, Daniel Goldstein, Simon Maybaum. (2010) A structured 3-step approach to evaluate cardiac recovery with continuous flow circulatory support. The Journal of Heart and Lung Transplantation 29:12, 1440-1442
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Emma J. Birks, Robert S. George. (2010) Molecular Changes Occurring During Reverse Remodelling Following Left Ventricular Assist Device Support. Journal of Cardiovascular Translational Research 3:6, 635-642
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Pankaj K. Bhavsar, Nigel J. Brand, Leanne E. Felkin, Pradeep K. Luther, Martin E. Cullen, Magdi H. Yacoub, Paul J. R. Barton. (2010) Clenbuterol Induces Cardiac Myocyte Hypertrophy via Paracrine Signalling and Fibroblast-derived IGF-1. Journal of Cardiovascular Translational Research 3:6, 688-695
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Hannah Zimmerman, Diane Covington, Richard Smith, Jack Copeland. (2010) Mechanical Support and Medical Therapy Reverse Heart Failure in Infants and Children. Artificial Organs 34:11, 885-890
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Jennifer L. Hellawell, Kenneth B. Margulies. (2010) Myocardial Reverse Remodeling. Cardiovascular Therapeuticsno-no
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Robert S. George, Nikant K. Sabharwal, Carole Webb, Magdi H. Yacoub, Christopher T. Bowles, Michael Hedger, Asghar Khaghani, Emma J. Birks. (2010) Echocardiographic assessment of flow across continuous-flow ventricular assist devices at low speeds. The Journal of Heart and Lung Transplantation 29:11, 1245-1252
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Drew Kuraitis, Erik J Suuronen, Frank W Sellke, Marc Ruel. (2010) The future of regenerating the myocardium. Current Opinion in Cardiology 25:6, 575-582
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Henriette Brinks, Walter J. Koch. (2010) βARKct: A Therapeutic Approach for Improved Adrenergic Signaling and Function in Heart Disease. Journal of Cardiovascular Translational Research 3:5, 499-506
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Francesco Moscato, Maurizio Arabia, Francesco M. Colacino, Phornphop Naiyanetr, Guido A. Danieli, Heinrich Schima. (2010) Left Ventricle Afterload Impedance Control by an Axial Flow Ventricular Assist Device: A Potential Tool for Ventricular Recovery. Artificial Organs 34:9, 736-744
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Carlo R. Bartoli, Guruprasad A. Giridharan, Kenneth N. Litwak, Michael Sobieski, Sumanth D. Prabhu, Mark S. Slaughter, Steven C. Koenig. (2010) Hemodynamic Responses to Continuous versus Pulsatile Mechanical Unloading of the Failing Left Ventricle. ASAIO Journal 56:5, 410-416
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Christopher A. Thunberg, Brantley Dollar Gaitan, Francisco A. Arabia, Daniel J. Cole, Alina M. Grigore. (2010) Ventricular Assist Devices Today and Tomorrow. Journal of Cardiothoracic and Vascular Anesthesia 24:4, 656-680
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Thomas J Povsic, Christopher M O’Connor. (2010) Cell therapy for heart failure: the need for a new therapeutic strategy. Expert Review of Cardiovascular Therapy 8:8, 1107-1126
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Carlo R. Bartoli, Gregory C. Wilson, Guruprasad A. Giridharan, Mark S. Slaughter, Leslie C. Sherwood, Paul A. Spence, Sumanth D. Prabhu, Steven C. Koenig. (2010) A Novel Subcutaneous Counterpulsation Device: Acute Hemodynamic Efficacy During Pharmacologically Induced Hypertension, Hypotension, and Heart Failure. Artificial Organs 34:7, 537-545
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Takashi Nishimura, Shunei Kyo. (2010) High-dose carvedilol therapy for mechanical circulatory assisted patients. Journal of Artificial Organs 13:2, 88-91
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Emma J. Birks. (2010) Myocardial Recovery in Patients with Chronic Heart Failure: Is It Real?. Journal of Cardiac Surgery 25:4, 472-477
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Stavros G. Drakos, Abdallah G. Kfoury, Elizabeth H. Hammond, Bruce B. Reid, Monica P. Revelo, Brad Y. Rasmusson, Kevin J. Whitehead, Mohamed E. Salama, Craig H. Selzman, Josef Stehlik, Stephen E. Clayson, Michael R. Bristow, Dale G. Renlund, Dean Y. Li. (2010) Impact of Mechanical Unloading on Microvasculature and Associated Central Remodeling Features of the Failing Human Heart. Journal of the American College of Cardiology 56:5, 382-391
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Shunsuke Saito, Goro Matsumiya, Taichi Sakaguchi, Shigeru Miyagawa, Takashi Yamauchi, Toru Kuratani, Yoshiki Sawa. (2010) Cardiac fibrosis and cellular hypertrophy decrease the degree of reverse remodeling and improvement in cardiac function during left ventricular assist. The Journal of Heart and Lung Transplantation 29:6, 672-679
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Robert S. George, Clare Khaghani, Christopher T. Bowles, Asghar Khaghani, Emma J. Birks. (2010) Sustained myocardial recovery 5 years after in situ disconnection of a Jarvik 2000 device. The Journal of Heart and Lung Transplantation 29:5, 587-588
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Taketoshi Maeda, Yoshihisa Tanoue, Mariko Kobayashi, Hironori Baba, Yuichi Shiokawa, Setsuo Takatani, Ryuji Tominaga. (2010) Early In Vivo Evaluation of Ventricular Assistance With a Miniature Centrifugal Blood Pump (TinyPump) in Rabbits. ASAIO Journal 56:3, 254-259
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I. George, L. T. Bish, G. Kamalakkannan, C. M. Petrilli, M. C. Oz, Y. Naka, H. Lee Sweeney, S. Maybaum. (2010) Myostatin activation in patients with advanced heart failure and after mechanical unloading. European Journal of Heart Failure 12:5, 444-453
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Monique L. Ogletree, Wendy E. Sweet, Cassandra Talerico, Mary E. Klecka, James B. Young, Nicholas G. Smedira, Randall C. Starling, Christine S. Moravec. (2010) Duration of left ventricular assist device support: Effects on abnormal calcium cycling and functional recovery in the failing human heart. The Journal of Heart and Lung Transplantation 29:5, 554-561
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L. H. Lund, J. Matthews, K. Aaronson. (2010) Patient selection for left ventricular assist devices. European Journal of Heart Failure 12:5, 434-443
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Paul F. Kantor, Luc L. Mertens. (2010) Clinical practice. European Journal of Pediatrics 169:4, 403-410
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Daniel J. Cantillon, Khaldoun G. Tarakji, Dharam J. Kumbhani, Nicholas G. Smedira, Randall C. Starling, Bruce L. Wilkoff. (2010) Improved survival among ventricular assist device recipients with a concomitant implantable cardioverter-defibrillator. Heart Rhythm 7:4, 466-471
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Paul F. Kantor, Jonathan R. Abraham, Anne I. Dipchand, Lee N. Benson, Andrew N. Redington. (2010) The Impact of Changing Medical Therapy on Transplantation-Free Survival in Pediatric Dilated Cardiomyopathy. Journal of the American College of Cardiology 55:13, 1377-1384
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Aurélie Cazes, Jean-Paul Duong Van Huyen, Paul Fornes, Catherine Amrein, Romain Guillemain, Jean-Michel Grinda, Patrick Bruneval. (2010) Mechanical ventricular assistance in heart failure: pathology of the cardiac apex removed during device implantation. Cardiovascular Pathology 19:2, 112-116
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Kenta Ito, Yutaka Kagaya, Hiroaki Shimokawa. (2010) Thyroid hormone and chronically unloaded hearts. Vascular Pharmacology 52:3-4, 138-141
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Jennifer NA Silva, Charles E Canter. (2010) Current management of pediatric dilated cardiomyopathy. Current Opinion in Cardiology 25:2, 80-87
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Cesare M. Terracciano, Leslie W. Miller, Magdi H. Yacoub. (2010) Contemporary Use of Ventricular Assist Devices. Annual Review of Medicine 61:1, 255-270
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Marc A. Simon, Brian A. Primack, Jeffrey Teuteberg, Robert L. Kormos, Christian Bermudez, Yoshiya Toyoda, Hemal Shah, John Gorcsan, Dennis M. McNamara. (2010) Left Ventricular Remodeling and Myocardial Recovery on Mechanical Circulatory Support. Journal of Cardiac Failure 16:2, 99-105
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Stavros G. Drakos, Theodoros Athanasoulis, Konstantinos G. Malliaras, John V. Terrovitis, Nikolaos Diakos, Dimitrios Koudoumas, Argirios S. Ntalianis, Stergios P. Theodoropoulos, Magdi H. Yacoub, John N. Nanas. (2010) Myocardial Sympathetic Innervation and Long-Term Left Ventricular Mechanical Unloading. JACC: Cardiovascular Imaging 3:1, 64-70
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Phornphop Naiyanetr, Francesco Moscato, Michael Vollkron, Daniel Zimpfer, Georg Wieselthaler, Heinrich Schima. (2010) Continuous assessment of cardiac function during rotary blood pump support: A contractility index derived from pump flow. The Journal of Heart and Lung Transplantation 29:1, 37-44
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Vegard Tuseth, Jan Erik Nordrehaug. (2009) Role of percutaneous left ventricular assist devices in preventing cerebral ischemia. Interventional Cardiology 1:2, 197-208
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Filippos Triposkiadis, George Karayannis, Grigorios Giamouzis, John Skoularigis, George Louridas, Javed Butler. (2009) The Sympathetic Nervous System in Heart Failure. Journal of the American College of Cardiology 54:19, 1747-1762
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Joshua B. Brown, William M. Hallinan, Howard T. Massey, Paul E. Bankey, Julius D. Cheng, Nicole A. Stassen, Ayodele T. Sangosanya, Mark L. Gestring. (2009) Does the need for noncardiac surgery during ventricular assist device therapy impact clinical outcome?. Surgery 146:4, 627-634
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Sean R. Wilson, Michael M. Givertz, Garrick C. Stewart, Gilbert H. Mudge. (2009) Ventricular Assist Devices. Journal of the American College of Cardiology 54:18, 1647-1659
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Jan Spillner, Rüdger Kopp, Thomas Finocchiaro, Mehdi Behbahani, Rolf Rossaint, Ulrich Steinseifer, Marek Behr, Rüdiger Autschbach. (2009) Assistierte Zirkulation: ein Überblick aus klinischer Sicht / Assisted circulation: an overview from a clinical perspective. Biomedizinische Technik/Biomedical Engineering 54:5, 255-267
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JR Lahpor. (2009) State of the art: implantable ventricular assist devices. Current Opinion in Organ Transplantation 14:5, 554-559
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Deborah Meyers. (2009) Medical therapies for the management of cardiomyopathy and chronic congestive heart failure. Current Cardiovascular Risk Reports 3:5, 315-322
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Mani A. Daneshmand, Carmelo A. Milano. (2009) Surgical Treatments for Advanced Heart Failure. Surgical Clinics of North America 89:4, 967-999
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Mark Harrison, Anelechi Anyanwu, Sean P. Pinney. (2009) The Management of Stage D Heart Failure. Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine 76:4, 404-414
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V Tsang, M Yacoub, S Sridharan, M Burch, R Radley-Smith, A Khaghani, B Savoldo, PJ Amrolia. (2009) Late donor cardiectomy after paediatric heterotopic cardiac transplantation. The Lancet 374:9687, 387-392
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Ross A. Breckenridge, Zia Zuberi, John Gomes, Robert Orford, Laurent Dupays, Leanne E. Felkin, James E. Clark, Anthony I. Magee, Elisabeth Ehler, Emma J. Birks, Paul J.R. Barton, Andrew Tinker, Timothy J. Mohun. (2009) Overexpression of the transcription factor Hand1 causes predisposition towards arrhythmia in mice. Journal of Molecular and Cellular Cardiology 47:1, 133-141
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Mads Andersen, Regitze Videbæk, Søren Boesgaard, Kåre Sander, Peter B. Hansen, Finn Gustafsson. (2009) Incidence of Ventricular Arrhythmias in Patients on Long-term Support With a Continuous-flow Assist Device (HeartMate II). The Journal of Heart and Lung Transplantation 28:7, 733-735
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Karl A. Soderlund, Raghu R. Chivukula, Stuart D. Russell, John V. Conte, James O. Mudd, Marc K. Halushka. (2009) Prognostic value of left ventricular apical tissue removed for HeartMate II left ventricular assist device placement. Cardiovascular Pathology 18:4, 217-222
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Enrique Lara-Pezzi, Cesare M. N. Terracciano, Gopal K. R. Soppa, Ryszard T. Smolenski, Leanne E. Felkin, Magdi H. Yacoub, Paul J. R. Barton. (2009) A Gene Expression Profile of the Myocardial Response to Clenbuterol. Journal of Cardiovascular Translational Research 2:2, 191-197
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