Dynamic cardiomyoplasty: At the crossroads

Background. Dynamic cardiomyoplasty remains a promising, but still unproven surgical treatment for patients with end-stage heart failure. Lack of a cl ear survival advantage and ongoing misunderstanding of its mechanism of act ion have hindered its acceptance as a treatment alternative for patients wi th end-stage heart failure. This review seeks to update current clinical re sults and practice of dynamic cardiomyoplasty and to present its likely mec hanism of action. Methods. The method involved a literature review. Results. More than 600 patients have undergone dynamic cardioplasty since 1 985. Improvement in average New York Heart Association class was noted in 8 0% to 85% of hospital survivors. Operative mortality has decreased from 31% in Phase I to less than 3% in the ongoing Phase III trial. Clinical work a s well as recent animal work supports the hypothesis that through a combina tion of long-term elastic constraint and active dynamic assist, dynamic car diomyoplasty decreases myocardial wall stress associated with the remodelin g process of progressive heart failure. Conclusions. Though dynamic cardiomyoplasty can be shown to limit the remod eling process of heart failure in animal studies and some patients, its ult imate role in the treatment of heart failure will depend on the outcome of randomized, controlled studies. (C) 1999 by The Society of Thoracic Surgeon s.