We challenge the hypothesis of enhanced myocardial reperfusion after implanting a left ventricular assist device\r\ntogether with bone marrow mononuclear stem cells in patients with end-stage ischemic cardiomyopathy.\r\nIrreversible myocardial loss observed in ischemic cardiomyopathy leads to progressive cardiac remodelling and\r\ndysfunction through a complex neurohormonal cascade. New generation assist devices promote myocardial\r\nrecovery only in patients with dilated or peripartum cardiomyopathy. In the setting of diffuse myocardial ischemia\r\nnot amenable to revascularization, native myocardial recovery has not been observed after implantation of an\r\nassist device as destination therapy. The hybrid approach of implanting autologous bone marrow stem cells during\r\nassist device implantation may eventually improve native cardiac function, which may be associated with a better\r\nprognosis eventually ameliorating the need for subsequent heart transplantation. The aforementioned hypothesis\r\nhas to be tested with well-designed prospective multicentre studies.
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