[Dynamic cardiomyoplasty: current status and concepts of the mechanism of action].

Surgical treatment of end-stage heart failure offers heart transplantation as a well established and effective treatment option. In addition, the permanent implantation of left-heart assist-devices is now gaining increasing importance. Yet, both methods also have inherent drawbacks and may not be available to all patients, so that new methods are constantly evaluated. Cardiomyoplasty was introduced into clinical practice 10 years ago, but still lacks general acceptance as a routine method. Worldwide results show a considerable symptomatic improvement with only small effects on systolic cardiac function. Survival rate was significantly improved by careful patient selection. As a mechanism of action the skeletal muscle wrap exerts some active improvement of systolic wall motion of the heart/skeletal muscle-complex. However, probably more important is an acute and chronically persisting shift of the pressure-volume relation to the left. This process results in a "reverse remodeling" of the insufficient heart with an improvement of the "contractility reserve". Cardiomyoplasty is indicated in patients with contraindications to heart transplantation and as a bridge-to-transplantation in patients with ventricular arrhythmia and severely impaired left ventricular function, concomitant with ICD implantation.