Introducing a hardware-in-the-loop simulation of the cardiovascular system
In dynamic cardiomyoplasty the latissimus dorsi of the patient is lifted as a pedicle graft, placed in the chest cavity, and the muscle is wrapped around the ventricles of the failing heart.' This muscle undergoes low frequency electrical stimulation for several weeks to confer fatigue resistance. The muscle is then stimulated by a synchronisable burst stimulator to contract during cardiac systole.2 Dynamic cardiomyoplasty has been proposed as both an alternative and a bridge to cardiac transplantation. Heart transplantation, a more established treatment, can rescue patients with terminal heart failure, often dramatically improving their quality of life. In contrast, because of high operative mortality, cardiomyoplasty is unsuitable for patients with terminal heart failure. The improvements in the quality of life and functional class in patients in New York Heart Association class III, with some exceptions,' are more modest than those achieved with transplantation. Nevertheless, cardiomyoplasty does not require a donor organ, there is no rejection, and no need for immunosuppression. It is also likely to cost less.