Mechanisms of dynamic cardiomyoplasty: current concepts

Dynamic cardiomyoplasty is an operation that is undergoing worldwide clinical evaluation. It had been developed to utilize the patient's own skeletal muscle to assist the failing heart. Although the clinical and quality of life benefits of cardiomyoplasty have been reported in most patients, the results of quantitative hemodynamic analyses have been less consistent. This has prompted the reevaluation of the mechanisms of dynamic cardiomyoplasty other than simple cardiac compression by the wrapped muscle. There is good evidence to suggest that the following, either together or in part, comprise some of the mechanisms of dynamic cardiomyoplasty: (1) direct systolic assist; (2) myocardial (wall stress) sparing effect; (3) remodeling/girdling effect; and (4) angiogenesis. Current concepts and potential additional mechanisms are discussed and integrated, based on a review of the literature and our own recent studies.