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Dynamic cardiomyoplasty: at the crossroads
1Division of Cardiothoracic Surgery, University of Pennsylvania School of Medicine, Philadelphia, USA. macker@mail.med.upenn.edu
Insights
Dynamic cardiomyoplasty shows promise for end-stage heart failure, improving patient class and reducing mortality. Further randomized trials are needed to confirm its role in limiting heart failure remodeling.
Area of Science:
- Cardiovascular Surgery
- Heart Failure Treatment
Background:
- Dynamic cardiomyoplasty is an emerging surgical option for end-stage heart failure.
- Its efficacy and mechanism of action require further elucidation.
- This review updates clinical outcomes and explores the mechanism of dynamic cardiomyoplasty.
Purpose of the Study:
- To review current clinical results and practice of dynamic cardiomyoplasty.
- To present the likely mechanism of action for dynamic cardiomyoplasty.
Main Methods:
- A comprehensive literature review was conducted.
Main Results:
- Over 600 patients have undergone dynamic cardiomyoplasty since 1985.
- 80-85% of hospital survivors showed improved New York Heart Association class.
- Operative mortality decreased from 31% to under 3% in Phase III trials.
- Evidence suggests dynamic cardiomyoplasty reduces myocardial wall stress, mitigating heart failure remodeling.
Conclusions:
- Dynamic cardiomyoplasty demonstrates potential in limiting heart failure remodeling in animal and some patient studies.
- Its definitive role in heart failure treatment awaits results from randomized, controlled studies.
Background:
Dynamic cardiomyoplasty remains a promising, but still unproven surgical treatment for patients with end-stage heart failure. Lack of a clear survival advantage and ongoing misunderstanding of its mechanism of action have hindered its acceptance as a treatment alternative for patients with end-stage heart failure. This review seeks to update current clinical results and practice of dynamic cardiomyoplasty and to present its likely mechanism of action.
Methods:
The method involved a literature review.
Results:
More than 600 patients have undergone dynamic cardioplasty since 1985. Improvement in average New York Heart Association class was noted in 80% 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 as well as recent animal work supports the hypothesis that through a combination of long-term elastic constraint and active dynamic assist, dynamic cardiomyoplasty decreases myocardial wall stress associated with the remodeling process of progressive heart failure.
Conclusions:
Though dynamic cardiomyoplasty can be shown to limit the remodeling process of heart failure in animal studies and some patients, its ultimate role in the treatment of heart failure will depend on the outcome of randomized, controlled studies.