**8. Conclusion**

In two groups of goats, skeletal muscle ventricles (SMVs) were shaped intra-thoracically [159], [160]. In group A (n=6) goat's LDM was not pre-stimulated and SMVs contracted by bursts of a mean pulse frequency of 5 Hz. This mean frequency of approximately 5 Hz has been used clinically in more than 1000 cases up to now, resulting in severe muscle damage as shown above in chapter 2.2. Group B, LDM with pre-stimulation over 14 days as shown above and with a controlled stimulation with a mean pulse frequency not exceeding 1Hz mean pulse frequency showed a preserved muscle tissue (figure 23, right). This new stimulation regime in group B became feasible by the newly available myostimulator with an integrated feature

for muscle protection (MyoSen ® Myostim GmbH, Wismar, Germany).

814 Regenerative Medicine and Tissue Engineering

Group A: 5 Hz Group B: 1 Hz

Musculus latissimus dorsi after 6 months of electrical stimulation

**Figure 23.** Histology of LDM 6 months after electrical stimulation with 5Hz and without pre-stimulation resulting in severe muscle damage (left) and LDM with pre-stimulation over 14 days and closed-loop controlled stimulation with a

This special kind of "electrical tissue engineering" of the LDM in situ 14 days before wrapping the LDM around the heart and a controlled electrical stimulation pattern with a reduced mean pulse frequency minor 1Hz should significantly increase the clinical efficacy of DCMP which has been described above. The new pre-stimulated, controlled cardiomyoplasty (CLC-CMP)

mean pulse frequency of 1Hz and preserved muscle tissue.

**7. DCMP vs. CLC- DCMP — Clinical implications**

DCMP has been effective clinically but did not fulfil the therapeutic expectations. Additional treatment processes like pre-stimulation in situ and CLC-DCMP-pacing may increase clinical efficacy for patients with a refractory medical treatment in NYHA III in future.
