Bridge to recovery with the use of left ventricular assist device and clenbuterol

Treatment of heart failure using a left ventricular assist device (LVAD) is emerging as one of the most rapidly expanding areas. These devices are now used to treat patients with terminal heart failure not only as a bridge to transplantation but also for a bridge to recovery in certain carefully selected patients. More recently we have developed a strategy of combining LVAD support with pharmacologic therapies to produce maximal reverse remodeling followed by the induction of physiologic cardiac hypertrophy using clenbuterol, a selective beta(2)-adrenergic receptor agonist (the Harefield protocol). The purpose of this communication is to provide a brief review of remodeling, reverse remodeling, and the rationale for the use of clenbuterol to enhance the efficacy of the LVAD. (C) 2003 by The Society of Thoracic Surgeons.