Ventricular assist device development has been an interesting and gratifying clinical area of advancement for the past several decades. Importantly, many patients have been saved from imminent death by appropriate application of ventricular assist devices and subsequent heart transplant. Most of these patients have been able to add years to their lives and enjoy good health. Of clinical interest, some degree of reverse remodeling process has been confirmed in many patients during the unloading period of the left ventricle on the ventricular assist device. Furthermore, a few patients have even demonstrated clinically significant myocardial recovery to the degree at which ventricular assist devices could be explanted safely.
Thus, the exact conditions under which myocardial recovery occurs and ways to enhance incidence of recovery are now under intense investigation. For example, Dr. Jacob Yacoub et al. (Imperial College School of Medicine, Heart Science Centre, Middlesex, UK) have used Clenbutrol, a |3-2 agonist, to promote left ventricular hypertrophy and subsequent ventricular assist device removal. This particular drug is under evaluation at other centers as well to validate the initial observation made in England. Such drugs may play an important role in promoting reverse remodeling in failing hearts. The role of the ventricular assist devices as a bridge therapy to myocardial recovery will remain as a very intriguing concept to explore. A combination of new drugs or stem cell infusion and short-term ventricular assist device support may prove to be helpful in successfully repairing failing hearts (11).
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