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Ann Thorac Surg 2005;79:1101-1103
© 2005 The Society of Thoracic Surgeons

Editorial

Cardiac Assistance From Skeletal Muscle: Should We Be Downhearted?

Stanley Salmons, MS, PhD*

Department of Human Anatomy and Cell Biology, University of Liverpool, Liverpool, United Kingdom

* Address reprint requests to Dr Salmons, British Heart Foundation Skeletal Muscle Assist Research Group, Department of Human Anatomy and Cell Biology, University of Liverpool, The Sherrington Buildings, Ashton St, Liverpool L69 3GE, UK; (E-mail: s.salmons@liverpool.ac.uk).

The first 20% of the full text of this article appears below.


   Introduction
 
Cardiac assistance from skeletal muscle offers an attractive solution to the problem of end-stage heart failure. Unlike transplantation, it does not carry the risks, debilitating side-effects and costs of long-term immunosuppression therapy. A donor patient (or animal) is not needed, and the patient's own heart is retained under conditions that offer the potential for myocardial recovery. This is an affordable technology that could be considered in parts of the world where other approaches, including mechanical pumps, would be too costly.

Currently, there is much interest in injecting stem cells into infarcted or peri-infarcted regions. Although this is part of a fashionable trend, the technique yields only milligrams of contractile tissue that are isolated electrically and mechanically from the rest of the myocardium. Real benefits—beyond an increase in wall compliance and some local angiogenesis-—remain a distant prospect. In contrast, the technology we are referring to here involves the surgical redeployment of hundreds of grams of existing, mature contractile tissue.

Early attempts at cardiac assistance were defeated by muscle fatigue. In 1979, Dr L. W. Stephenson and I initiated a fresh approach, incorporating "conditioning": a marked increase in fatigue resistance that was part of the adaptive response of skeletal muscle to long-term electrical stimulation [1]. The results were impressive and engendered new interest in the field. In several centers, surgical techniques were developed that allowed a nonessential muscle, usually latissimus dorsi (LD), to be transferred into the chest and configured to provide cardiac assistance. Two techniques, dynamic cardiomyoplasty and aortomyoplasty, were tried clinically.

There is now a widespread perception that the approach has failed to fulfill its promise. It is time to revise that view.


   Harnessing the Power
 
Cardiomyoplasty
Wrapping the LD muscle around the failing . . . [Full Text of this Article]






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