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Medical devices are often life-saving therapies in patients with advanced heart failure whose condition worsens despite optimal medical therapy. Drs Abraham and Smith expertly review the development of cardiac resynchronization therapy and left ventricular assist devices, describe the current challenges associated with these treatment strategies, and speculate on future advances in this fast-moving field.
In the diseased heart, cardiomyocytes undergo necrotic cell death. A healing response results in myofibroblast production of collagen and other matrix molecules, which initially serve to preserve the structural integrity of the myocardium. However, myofibroblast dispersion fails to occur in many cardiac diseases, and perpetual matrix formation leads to adverse remodelling of the heart. In this Review, Weber et al. discuss relevant mechanisms of cardiac fibrosis and consequent remodelling, and highlight potential strategies for cardioprotection.
The success of transcatheter therapeutics relies heavily on the choice of vascular access site and on adequate arteriotomy closure. In this article, Byrne and colleagues review the state-of-the-art and future developments in vascular closure devices. They also compare the safety and efficacy of radial artery and femoral artery access for diagnostic and interventional procedures.