Mechanical 'artificial hearts' can be used to return severely failing hearts to their normal function.¹   This device is set to reduce the need for heart transplantation.² Worldwide, heart failure is a major cause of death. Myocardial remodelling is a complex process; however, it has been found that certain aspects of it can be reversed.

A study conducted by Birks et al. involved 15 patients, each with severe heart failure due to non-ishchaemic cardiomyopathy and with no histologic evidence of active myocarditis. Combination therapy was used to treat these patients. This involved the implantation of a left ventricular assist device (LVAD) and the administration of drugs known to enhance reverse remodelling (lisinopril, carvedilol, spironolactone and losartan), followed by clenbuterol. The LVAD is connected to the left ventricle via a tube which removes the oxygen rich blood and then pumps it via another tube into the aorta and hence to the rest of the body.

On analysis of the results of this trial, it was shown that 11 patients had sufficient myocardial recovery to undergo explantation of the mechanical device approximately 320 days after implantation. Four years after explantation the cumulative rate of freedom from recurrent heart failure was 88.9%, and after the three years the quality of life for surviving patients was nearly normal according to an assessment by the Minnesota Living with Heart Failure Questionnaire.

In a news release¹ Dr Birks said, “Donor heart transplant has for many years been the gold standard in the treatment of those with severe heart failure. It has proven greatly successful but is not without its shortcomings – particularly the shortage of donor hearts and the risk of organ rejection.
 
“This therapy has the potential to ease the pressure on the waiting list while also offering patients a better alternative to a donor heart – their own, healthy heart.”  

References
1.  News Release:  Mechanical 'artificial hearts' can be used to return severely failing hearts to their normal function, potentially removing the need for heart transplantation, according to new research.: http://www3.imperial.ac.uk/newsandeventspggrp/imperialcollege/newssummary/news_2-11-2006-11-53-29
2.  Birks EJ, Tansley PD, Hardy J, et al. Left ventricular assist device and drug therapy for the reversal of heart failure. N Engl J Med. 2006; 355(18):1873-1884.

Jaish Kumar Puri, BSc
Medical Student
King’s College London