AN INNOVATIVE PROCEDURE is muscling its way into the cardiac surgeon's repertoire. Known as cardiomyoplasty, it involves fashioning the patient's own back muscle into a wrap that embraces the heart. Surgeons here and abroad are reporting encouraging early results, holding out hope for the thousands of persons with end-stage heart failure who cannot withstand the rigors of bypass surgery or a transplant.
Meanwhile, a more complex procedure—using skeletal muscle pouches to augment, ventricular function—appears to be back on track after initial promise turned to disappointment (JAMA 1986; 255:1977-1979, 1987;257:2001). Investigators predict this approach eventually will prove successful, but are still working out the ideal configuration.
Cardiomyoplasty was introduced in Europe in the mid-1980s. Surgeons remove a rib, free one of the latissimus dorsi muscles from connective tendons, snake it through the rib cage, and wrap it over the heart, preserving the thoracodorsal nerve and major blood vessel. A