Background: Cardiac transplantation is an option for only a small minority
of patients with severe, chronic congestive heart failure. Transformed skel
etal muscle has the potential to provide a durable form of fatigue-resistan
t muscle power to assist the cardiovascular system.
Methods: Since the first dynamic cardiomyoplasty performed by Carpentier an
d colleagues in 1985, the techniques to make this operative procedure an ef
fective assist to the failed myocardium have been refined. Much has been le
arned about optimum patient selection so that perioperative morbidity and m
ortality is minimized. The cardiomyostimulator developed by Medtronic has u
ndergone 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 patie
nts who undergo the procedure experience an enhanced quality of life, and a
n alleviation of their heart failure symptoms. Details of patient selection
underscore that cardiomyoplasty is not an alternative to transplant. Serio
usly 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 fo
r patients with moderately-severe congestive heart failure (i.e. NYHA Class
III patients). The ongoing randomized trial comparing cardiomyoplasty to s
tandard medical therapy is expected to provide more detailed information ab
out the benefits of this procedure.