[Dynamic cardiomyoplasty: models of action and indications]

Cardiomyoplasty, proposed as an alternative to cardiac transplantation for the first time in 1985, has been carried out in over 500 patients over the world. The functional improvement after the procedure may be spectacular. The haemodynamic improvement at rest is generally small in terms of pre and postoperative ejection fractions. A dynamic effect of systolic assistance due to stimulation of the latissimus dorsi may be demonstrated in some cases by analysis of ventricular pressure-volume curves. However, it is probable that cardiomyoplasty prevents ventricular remodelling (girdling effect) and that chronic stimulation of latissimus dorsi, necessary to prevent atrophy and fibrosis, reduces wall stress. Therefore, many mechanisms, probably associated, may explain the clinical efficacy of cardiomyoplasty. Though the contraindications of this technique are now better known, its role with respect to cardiac transplantation in cases of severe congestive cardiac failure resistant to medical therapy still remain undefined.