**Autologous Muscular Treatment Options for Endstage Heart Failure — A Critical Appraisal of the Dynamic Cardiomyoplasty (DCMP) vs. a New Concept of a Closed-Loop Controlled DCMP (CLC-DCMP)**

Norbert W. Guldner, Peter Klapproth and Hans-H. Sievers

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/55900

**1. Introduction**

Dynamic cardiomyoplasty (DCMP) aims at improving cardiac function in cases of severe heart failure by wrapping the latissimus dorsi (LD) muscle, (usually left LD) around the ventricles and stimulating it electrically, synchronously to the ventricular function (Figure 1, Figure 2). It is a surgical treatment option mostly for pharmacologically untreatable heart failure. The first successful clinical application was performed in 1985 (Broussais Hospital, Paris, [1]). Since then, more than 1.000 surgeries have been performed worldwide [2]. The clinical results of the DCMP however did not live up to the expectations due to the loss of muscle strength [3][4] and muscle damage [5][6].

In DCMP, a special kind of tissue engineering is applied using an electric stimulation on autologous skeletal muscles (electrical muscular tissue engineering). The fiber type changes from the fatiguing type IIa to the fatigue resistant type I [7], [8]. Type IIx fibers disappear. The gene expression for myosin heavy chains IIa (MHCII) is changed into heavy chains I (MHCI) [3]. Intramuscular collaterals are opened [9], [10] and enhanced and capillary density is increased [11].

A critical analysis of more than 20 years and more than 1.000 clinical cases should demonstrate it's clinical impact [1], [2], [4–6], [12–145]. Clinical efficacy concerning survival, clinical outcome indicated by NYHA- class, ejection fraction of the left heart ventricle (EF) was evaluated by the use of more than 100 relevant reports. A comparison of the DCMP therapy

**Figure 1.** Latissimus dorsi muscle (LDM) is dissected free from the left thoracic wall before placing it into the thoracic cavity via a window of the thoracic wall after a partial resection of the second rib. Artery, vein and nervus thoracodorsalis remain untouched. LDM's tendon is cut (arrow) before it's re-fixation to the thoracic wall. Two stimulation electrodes are placed wavelike around the branches of nervus thoracodorsalis at a distance of 6 cm.

to other treatment options for end-stage heart failure is performed in this report. And last but not least new experimental insights concerning the DCMP procedure should be demonstrated. This experience from clinical application over more than 20 years and new experimental data about dynamic cardiomyoplasty procedures should become compared and discussed. From these insights, conclusions should be drawn to improve clinically results from DCMP which are needed urgently for a more effective treatment of pharmacologically non-treatable heart failure.

**Figure 2.** When latissimus dorsi muscle (LDM) has been transferred intra-thoracally it is wrapped around the heart and stimulated electrically by a myostimulator via two muscular electrodes near the branches of the thoraco-dorsal nerve. Stimulation bursts are synchronized with the heart action via additional epicardial sensing electrodes.
