[Skeletal muscle-powered cardiac assist and dynamic cardiomyoplasty]

Despite recent technical advances in cardiac surgery, profound refractory heart failure remains a significant cause of mortality. The idea of utilizing skeletal muscle grafts as a functioning substitute for the damaged myocardium has been tried in experimental studies since Kantrowitz's report in 1959. Recent works by Salmons et al has demonstrated that skeletal muscle could be transformed into a fatigue-resistant state due to changes in its ultrastructure, metabolism and physiologic properties. Several investigators at the University of Pennsylvania introduced the concept of electrical preconditioning for cardiac assistance and demonstrated the long-term possibility to augment cardiac function using canine Latissimus Dorsi muscle. A clinical extension of these promising experimental studies was performed by Carpentier in France in 1985. Today possible surgical procedures include "Biomechanical Cardiac Assist Device" (the cardiac assist device powered by skeletal muscle) and "Dynamic Cardiomyoplasty" (using skeletal muscle graft to either replace or augment myocardium as a functioning substitute). We will review the experimental and clinical applications of electrically transformed skeletal muscle for diseased hearts, and outline the present status and the future perspective.