Cardiomyoplasty provides excellent symptomatic improvement in most surviving patients with end-stage heart failure, although objective hemodynamic effects have not been consistently demonstrated.
Does cardiomyoplasty improve hemodynamics and symptoms in patients with end-stage heart failure?
Cardiomyoplasty provides symptomatic improvement but inconsistent objective hemodynamic effects in end-stage heart failure.
Skeletal muscle cardiac assist (SMCA) is emerging as a promising form of surgical treatment for end-stage heart failure.In one form, cardiomyoplasty, the muscle is wrapped around the heart and then activated by electrical stimulation to augment myocardial contraction.1Cardiomyoplasty has been performed in more than 400 cases worldwide with variable degrees of success.Despite excellent symptomatic improvement in the majority of patients surviving the procedure, objective hemodynamic effects have not been consistently demonstrated.2,3The hemodynamic effect of cardiomyoplasty has been the subject of a great deal of experimental and clinical research over the past decade.This article discusses in detail the published results of experimental and clinical cardiomyoplasty, with particular emphasis on hemodynamic effects and limitations of the procedure.Other forms of experimental SMCA, including aor- tomyoplasty, skeletal muscle ventricles, and biomechan- ical assist devices, were reviewed recently4-6 and there- fore are not discussed here.Need for Cardiac Assistance Chronic heart failure is a clinical entity characterized by left ventricular dysfunction, impaired quality of life, and markedly shortened life expectancy.7The overall 1- and 5-year survival rates are 57% and 25% in men and 64% and 38% in women, respectively.8Survival rates in patients with new-onset heart failure after acute myo- cardial infarction are even lower, with only a small minority remaining alive at 5 years.9Today, despite optimal pharmacological therapy, mortality due to con- gestive heart failure remains unacceptably high.10Cardiac transplantation has revolutionized the man- agement of end-stage heart disease,11 with 5-and 10-year survival rates of 66% and 52%, respectively.1However, the disparity between the number of donor organs available and the number of transplant candi- dates limits this option to a minority of patients.13Xenotransplantation offers a potential solution to the problem of lack of donor organs, but even in the primate
Oakley et al. (Sat,) conducted a review in End-stage heart failure. Cardiomyoplasty was evaluated. Cardiomyoplasty provides excellent symptomatic improvement in most surviving patients with end-stage heart failure, although objective hemodynamic effects have not been consistently demonstrated.