Fifteen years ago Larry Stevenson, in his memorable lectures, pointed to the great sheet of muscle that is the latissimus dorsi, and proposed that this potential power source should be harnessed for the purpose of circulatory assistance, and put to much better use as a cardiac muscle in patients handicapped and dying of heart failure.1Salmons and others2 ,3 had demonstrated that this fast twitch fatiguable muscle retained within its genome the potential to be transformed into a slow contracting, fatigue resistant phenotype, similar to cardiac muscle. The logic seemed inescapable. It seemed inevitable that this resource would be used routinely to rescue the many with shortened miserable lives because of end stage heart failure.4 The combination of advances in muscle physiology, electronic engineering, and experimental surgery,5-7 culminated in 1985 in the first successful use of stimulated skeletal muscle to aid the circulation8in a patient with a left ventricular defect following excision of a tumour. That patient has survived—unlike the operation that saved her life. What happened?

Four UK units embarked on well thought out and carefully planned collaborative trials of …