A review of the concept of circulatory bioassist focused on the "new" demand dynamic cardiomyoplasty: the renewal of dynamic cardiomyoplasty?
After the initial enthusiasm, the dynamic cardiomyoplasty lost its reputation owing to the poor long-term results, caused by the muscular degeneration subsequent to chronic continuous electrical stimulation of the latissimus dorsi. An activity-rest stimulation protocol that avoids full transformation of the skeletal muscle, maintaining muscular properties over time, has been successfully tried. This "demand" stimulation protocol showed in humans good results improving NYHA class, ejection fraction value, and survival. The discussion about the capability of this and a unique kind of cardiocirculatory bioassist is due to be reopened. In fact, heart transplant, percutaneous circulatory-supporting device, multisites stimulation therapy, and total artificial heart have some drawbacks, one of which is the economic cost. In developing countries the more economic demand dynamic cardiomyoplasty may still play a role.
Rigatelli
Gianluca
G
Cardiomyoplasty Project Unit, Legnago General Hospital, Verona, Italy. jackyheart@hotmail.com
Carraro
Ugo
U
Barbiero
Mario
M
Riccardi
Roberto
R
Cobelli
Franco
F
Gemelli
Marzio
M
Rigatelli
Giorgio
G
D002311:Cardiomyopathy, Dilated / Q000503:physiopathology / Q000601:surgery*; D018421:Cardiomyoplasty / Q000379:methods*; D004599:Electric Stimulation Therapy / Q000379:methods*; D006354:Heart, Artificial; D006801:Humans; D018482:Muscle, Skeletal / Q000502:physiology; D019739:Skeletal Muscle Ventricle / Q000502:physiology*