Helping your heart recover while an LVAD supports it
The Myocardial Recovery Program at Banner – University Medical Center Tucson is for people living with a left ventricular assist device (LVAD), a mechanical pump implanted alongside the heart that takes over much of the work of pumping blood. The goal is to help the heart muscle grow stronger while the pump supports it, using careful monitoring, medicines and specialized testing.
In some patients, the heart muscle improves over time. The program looks carefully for signs of recovery and supports the heart’s ability to heal, with safety always the first priority. For selected patients, recovery can mean turning down the LVAD’s support or removing the pump altogether.
What the program offers:
- Recovery-focused care planned for each patient
- Advanced imaging and hemodynamic assessment, which measures pressure and blood flow inside the heart
- Heart failure medicines adjusted to guideline-recommended targets
- Structured protocols for adjusting LVAD speed and weaning support
Who the program is for
People with an LVAD whose heart function may be improving, or who want to be evaluated for their potential to recover.
The goal
To strengthen the heart safely and, in selected patients, to find out whether LVAD support can be reduced or the device removed.
Recovery looks different for every patient. Even a small improvement in heart function can ease symptoms and improve energy and quality of life.
Pairing LVAD support with intensified heart failure medicines is an approach Carl Tong, MD-PhD, calls myocardial repair. The pump rests, or unloads, the weakened heart muscle while the medicines help it heal.
Heart failure stages
Heart failure usually develops in stages. It moves from risk factors (Stage A), to changes in the heart without symptoms (Stage B), to heart failure with symptoms (Stage C), to advanced heart failure that continues despite treatment (Stage D). LVAD-supported recovery is considered for patients with advanced heart failure.
Many conditions and diseases can cause heart failure, including:
- Aging
- Cancer treatment
- Cardiovascular disease
- Endocrine disorders
- Infections, such as COVID-19
- Mutations
- Pregnancy
- Stress
- Toxicities
Explore heart failure progression and treatment options
The interactive version of this chart could not load. A description of the chart and the treatment options follows.
Treatment options
- Myocardial Repair (LVAD support + medicines · from Stage D toward Class I, around Stage C) A left ventricular assist device (LVAD) takes over much of the heart’s pumping work. This lets the heart rest and recover while medical treatment is intensified. When there are enough signs of recovery, the care team gradually weans the LVAD. If the heart keeps showing recovery during weaning, the LVAD can be removed and the heart can work on its own. However, not every heart recovers.
- Medicines (guideline-directed medical therapy) (Stage C · Maintain: stay stable and don’t get worse) Guideline-directed medical therapy can slow heart failure progression and, in some patients, improve cardiac function. “Maintain” means staying stable — not getting worse. From there, a patient may later improve with treatment, or the disease may continue to progress.
- Heart transplant (From Stage D · toward Class I and the Stage A/B region) For patients who need a heart transplant and qualify for one, transplant can be performed at Banner – University Medical Center Phoenix. A transplant can return patients to their normal function. It requires long-term immunosuppressive medicines and ongoing monitoring. An LVAD can also serve as a bridge to transplant.
- Destination LVAD (Stage D · stabilized while the pump stays in place) With destination therapy, the LVAD stays in place and continues to perform the heart’s pumping function. Patients can live with improved function and minimal symptoms for a long time. Unlike recovery or transplant, however, they depend on the LVAD for the rest of their lives.
- Chronic inotrope infusion therapy (Late Stage D · toward Class III; shorter-lasting benefit) Some patients do not qualify for, or are not good candidates for, an LVAD or heart transplant. For them, a chronic intravenous (IV) infusion of medicines that help the remaining heart pump more efficiently can be used. Patients usually have fewer symptoms and better physical function. However, the benefit lasts much less time than with an LVAD or heart transplant.
- First admission / reversible causes (Opportunity at the first hospitalization (Stage B → C) · toward Class I and an earlier disease state) At a first hospital admission for heart failure, the care team looks for reversible causes. Finding and treating a reversible cause can restore the heart. Examples include coronary artery disease, thyroid dysfunction, atrial tachycardia and early-stage toxicity from alcohol, illicit drugs or medications.
Text description of this chart
Illustration only. Height shows overall physical function, grouped by New York Heart Association Functional Class; it is not a measured score. Every patient’s course is different. Illustrative course; stage widths and timing are not to scale.
The chart plots whole-body function on the vertical axis, grouped into New York Heart Association Functional Classes I to IV, with Class I at the top. The horizontal axis shows heart failure stage (ACC/AHA Stages A, B, C and D, from left to right), with a separate arrow showing that time moves forward. Up and to the left means better function and an earlier disease state — time still moves forward.
Stages (left to right):
- Stage A: The patient has a condition that can lead to heart failure, such as high blood pressure or diabetes, but no detectable heart dysfunction.
- Stage B: The patient has an underlying condition and detectable heart dysfunction (for example, diastolic dysfunction seen on an echocardiogram) but has no heart failure symptoms.
- Stage C: The patient has heart failure symptoms but can still improve.
- Stage D: The patient has refractory heart failure symptoms, which continue despite treatment.
- Death: Without advanced therapies, advanced heart failure is ultimately fatal.
New York Heart Association Functional Classes (top to bottom):
- Class I: No limitation. Ordinary physical activity does not cause symptoms.
- Class II: Mild limitation. Comfortable at rest; ordinary activity causes symptoms.
- Class III: Marked limitation. Comfortable only at rest; less than ordinary activity causes symptoms.
- Class IV: Severe limitation. Symptoms occur even at rest.
Typical course: The red line starts high, in Functional Class I, through Stages A and B. The first hospitalization, at the boundary between Stage B and Stage C, causes a sudden, nearly vertical drop to the bottom of Class IV. Function then partly recovers. Every later hospitalization drops to that same lowest level; each recovery is less complete than the last, and hospitalizations come closer together. In Stage D, recoveries are small and frequent, and the line finally declines to death.
Treatment pathways:
- Myocardial Repair (medicines + LVAD): from a hospitalization early in Stage D, the pathway rises up and to the left while the LVAD supports the heart (dashed). The LVAD is then removed, and the line continues solid, on the patient’s own heart, to Functional Class I in the Stage C region.
- Medicines: after recovering from the first hospitalization, a two-headed horizontal arrow labelled Maintain holds function steady in Class II, pointing both left (possible improvement) and right (possible progression).
- Heart transplant: from a hospitalization in Stage D, a large blue arrow sweeps up and to the left, toward Functional Class I and the Stage A/B region, staying below the original baseline.
- Destination LVAD: from a hospitalization early in Stage D, the pathway rises to about Class II and levels off, dashed throughout to show continuing pump support, remaining in Stage D.
- Chronic inotrope infusion therapy: from a hospitalization late in Stage D, the pathway rises to Functional Class III and levels off, reflecting reduced symptoms and improved physical function.
- First admission / reversible causes: finding and treating a reversible cause can restore the heart. From the first hospitalization, a teal arrow rises up and to the left, toward Functional Class I and the Stage B region, staying below the original baseline.
References
- Saeed D, Feldman D, Banayosy AE, Birks E, Blume E, Cowger J, Hayward C, Jorde U, Kremer J, MacGowan G, et al. The 2023 International Society for Heart and Lung Transplantation Guidelines for Mechanical Circulatory Support: A 10-Year Update. J Heart Lung Transplant. 2023;42:e1–e222. doi: 10.1016/j.healun.2022.12.004
- Birks EJ, Drakos SG, Patel SR, Lowes BD, Selzman CH, Starling RC, Trivedi J, Slaughter MS, Atluri P, Goldstein D, et al. Prospective Multicenter Study of Myocardial Recovery Using Left Ventricular Assist Devices (RESTAGE-HF [Remission from Stage D Heart Failure]): Medium-Term and Primary End Point Results. Circulation. 2020;142:2016–2028. doi: 10.1161/CIRCULATIONAHA.120.046415
- Papolos AI, Kenigsberg BB, Singam NSV, Berg DD, Guo J, Bohula EA, Katz JN, Diepen SV, Morrow DA, Critical Care Cardiology Trials Network I. Pulmonary Artery Diastolic Pressure as a Surrogate for Pulmonary Capillary Wedge Pressure in Cardiogenic Shock. J Card Fail. 2024;30:853–856. doi: 10.1016/j.cardfail.2024.02.021
- Feuerstein A, Schoenrath F, Belyavskiy E, Knierim J, Friede T, Placzek M, Bach D, Pieske-Kraigher E, Herrmann-Lingen C, Westenfeld R, et al. Supervised exercise training in patients with advanced heart failure and left ventricular assist device: A multicentre randomized controlled trial (Ex-VAD trial). Eur J Heart Fail. 2023;25:2252–2262. doi: 10.1002/ejhf.3032
- Anson M, Zhao SS, Austin P, Ibarburu GH, Malik RA, Alam U. SGLT2i and GLP-1 RA therapy in type 1 diabetes and reno-vascular outcomes: a real-world study. Diabetologia. 2023;66:1869–1881. doi: 10.1007/s00125-023-05975-8
What to expect
Careful heart assessment
Your care team tracks how your heart is responding with:
- Repeated echocardiograms, ultrasound images of the heart taken through the chest wall (serial transthoracic echocardiography)
- Right heart catheterization, which measures pressures inside the heart through a thin tube
- Exercise and functional testing
- Blood biomarkers and other laboratory tests
Heart medicines
- Guideline-directed heart failure medicines
- Afterload reduction: medicines that lower the resistance the heart has to pump against
- Monitoring for heart rhythm problems, and treatment when needed
LVAD adjustments
- Pump speed optimized according to a set protocol
- Gradual changes to how much of the heart’s work the pump takes over
- Weaning trials guided by pressure measurements inside the heart, to test how well the heart performs with less pump support
Your care team
Specialists in advanced heart failure cardiology, cardiac surgery, cardiac imaging, nursing, rehabilitation and transplant work together on each patient’s plan.
You are part of the team
Education, shared decision-making and scheduled follow-up help patients understand the goals, what to expect and the safety considerations at each step.
Research
Patients may have the opportunity to take part in clinical research that aims to define who recovers, why their hearts recover and how they do afterward.
Leadership
The program is led by Carl Tong, MD-PhD, clinical professor of medicine at the University of Arizona College of Medicine – Tucson and medical director of heart failure at Banner – UMC Tucson. Tong is a physician-scientist who specializes in advanced heart failure and transplant cardiology. Before coming to Tucson, he helped rescue a new heart transplant program and start a new LVAD program in Texas. His research includes LVAD heart recovery, noninvasive monitoring devices and new treatments based on the heart’s contractile proteins.
Your clinical pathway
Step 1: Referral
You or your doctor request an evaluation through the Banner – University Medical Center Tucson advanced heart failure team.
Step 2: Evaluation
The team uses heart imaging, laboratory tests and sometimes catheter-based measurements to understand your heart’s potential to recover.
Step 3: Recovery plan
Your team adjusts your medicines and LVAD settings and follows your progress closely over time.
Step 4: Reassessment
If your heart keeps improving, you and your team discuss next steps. These may include continued long-term support, reduced LVAD support or, in selected cases, removal of the device.
Possible benefits
Recovery can bring:
- A smaller, stronger left ventricle, the heart’s main pumping chamber
- Fewer heart failure symptoms
- Better exercise tolerance and quality of life
- For selected patients, eligibility to have the LVAD removed (explantation)
Not every patient will be a candidate for having the device removed. Even partial recovery can bring meaningful clinical benefits and help guide long-term care.
Carl Tong, MD-PhD
Clinical Professor, Medicine
Medical Director, Advanced Heart Failure
Banner – University Medical Center Tucson
Referrals and consultations
The program welcomes referrals for LVAD patients with suspected or potential myocardial recovery.
Patients can ask their cardiologist or LVAD team about a referral.
Email: AdvancedHF@bannerhealth.com
Phone: 520-694-6299
Fax: 520-694-2692