Dynamic cardiomyoplasty: expectations and results.

ABSTRACT

BACKGROUND: Cardiac transplantation is an option for only a small minority of patients with severe, chronic congestive heart failure. Transformed skeletal muscle has the potential to provide a durable form of fatigue-resistant muscle power to assist the cardiovascular system. METHODS: Since the first dynamic cardiomyoplasty performed by Carpentier and colleagues in 1985, the techniques to make this operative procedure an effective assist to the failed myocardium have been refined. Much has been learned about optimum patient selection so that perioperative morbidity and mortality is minimized. The cardiomyostimulator developed by Medtronic has undergone several revisions, primarily so that the stimulation of the muscle wrap is adaptive to variations in cardiac performance, such as those that occur with arrhythmia or during exercise. RESULTS: A review of the data to date suggest a substantial number of patients who undergo the procedure experience an enhanced quality of life, and an alleviation of their heart failure symptoms. Details of patient selection underscore that cardiomyoplasty is not an alternative to transplant. Seriously compromised patients with low peak oxygen uptake and very low ejection fractions have the highest short term mortality. CONCLUSIONS: Dynamic cardiomyoplasty remains a promising surgical option for patients with moderately-severe congestive heart failure (i.e. NYHA Class III patients). The ongoing randomized trial comparing cardiomyoplasty to standard medical therapy is expected to provide more detailed information about the benefits of this procedure.