Early “Heart Training” Surgery Promotes Regeneration in Pediatric Heart Failure

Dilated cardiomyopathy, an enlargement of the heart muscle that weakens systolic function, leaves critically ill children with few effective therapies. Clinicians must often bridge prolonged heart failure with limited surgical or device-based options. Early strategies that could restore function by harnessing intrinsic repair would change care pathways and outcomes. To help address this challenge, investigators have explored an early “heart training” surgery designed to trigger endogenous regenerative responses.

Pulmonary artery constriction, also known as banding, is being applied in select centers to deliberately increase right ventricular afterload and “train” the failing heart. Researchers at University Hospital Bonn and the University of Bonn examined why early application of this approach appears beneficial. They report that clinical experience to date has been encouraging, yet adoption remains limited because the underlying biology has not been well defined.

Using neonatal mouse models at the Institute of Physiology I and the Department of Neonatology and Pediatric Intensive Care Medicine, the team induced pressure overload in a single ventricle shortly after birth. The early postnatal stress activated a regeneration program in both ventricles, increasing cardiomyocyte proliferation and promoting new vessel formation. These synchronized changes point to “ventricular crosstalk,” in which the nonbanded ventricle responds alongside the overloaded chamber to support balanced growth.

Timing emerged as a critical determinant. When the intervention was delayed to seven days after birth, the regenerative response was lost and replaced by hypertrophic cardiomyocyte growth, a pattern associated with progressive functional decline. The findings help explain why only very early surgical “heart training” may contribute to recovery in infants with severely reduced pump function, including those with dilated cardiomyopathy. The work was published in Circulation in 2026.

“Regardless of whether the pressure overload was induced in the right or left ventricle, the unaffected ventricle also responded,” said Dr. Fabian Ebach, BONFOR fellow at the University of Bonn and specialist in the Department of Neonatology and Pediatric Intensive Care Medicine.

“This points to a previously unknown mechanism of ‘ventricular crosstalk,’ in which both ventricles of the heart communicate with each other and synchronize their growth,” said Julia Nicke, co-first author.

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