Cardiomyoplasty: A renaissance of an abandoned technique

Dynamic cardiomyoplasty (DCM), introduced in the 1980s, was a pioneering attempt to treat end-stage heart failure using autologous skeletal muscle to provide biological cardiac support. Although it initially improved functional status, DCM was abandoned due to a "mechanical paradox," the technique failed to deliver consistent hemodynamic benefits and suffered from chronic muscle degeneration, including fatty infiltration and atrophy. This narrative review explores the history, mechanisms, and evolution of this concept, synthesizing relevant publications, early experimental foundations, objective clinical outcomes, and the transition from biological grafts to modern innovation, namely soft robotic cardiac sleeves. Unlike the original biological approach, these emerging technologies utilize programmable synthetic actuators that overcome biological fatigue and fatty degeneration. Crucially, they preserve DCM's "non-blood-contacting" advantage, which eliminates the need for lifelong anticoagulation, a major complication of current mechanical circulatory support devices. This evolution marks a shift toward a new paradigm in bio-robotic engineering, where precise, synchronized external support can be achieved through advanced materials. The transition from biological muscle flaps to synthetic soft robotics revitalizes the core principles of cardiomyoplasty. By integrating modern engineering with these established surgical concepts, soft robotic sleeves offer a potentially sustainable, biocompatible, and accessible alternative for the global management of advanced heart failure.