Dynamic cardiomyoplasty.

In end-stage heart failure marked by progressive impairment of myocardial function, enlarged chamber size, and excessive workload, dynamic cardiomyoplasty may have a direct role in improving the mechanical conditions of the left ventricle and increasing its contractility on a long-term basis. The chronic use of positive inotropic drugs; e.g., amrinone and milrinone, in end-stage cardiomyopathy has not been beneficial because of the severely limited contractile reserve of the heart and progressive myocardial cell damage related to extreme workloads and disadvantaged myocardial energetics. In contrast, dynamic cardiomyoplasty enhances left ventricular contractility with an extrinsic energy source (the muscle wrap), and in theory, at decreased levels of myocardial oxygen requirement because of associated workload reduction. These conceptual advantages are supported by the functional and mechanical data from the laboratory. Although clinical experience with the procedure is still largely experimental, dynamic cardiomyoplasty may have an important future role in the treatment of end-stage congestive heart failure.