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The Journal of Thoracic and Cardiovascular Surgery, Vol 91, 534-544, Copyright © 1986 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
JD Mannion, R Hammond and LW Stephenson
We have studied the fatigue rates of hydraulic pouches constructed in the
form of a multilayered conical spiral using the latissimus dorsi muscle of
17 beagles. The roles that electrical muscle conditioning and early
interruption of collateral blood supply have in the prevention of pouch
fatigue were evaluated. The length of time that a pouch could generate flow
in a hydraulic test system was measured; afterload was set at 80 mm Hg and
preload 24 mm Hg. Pouches (N = 3) fashioned from muscles subject to neither
electrical conditioning nor a vascular delay generated an initial flow of
990 +/- 346 ml/min, but could sustain flow for only 2.3, 3.8 and 3.6
minutes. Pouches (N = 5) constructed with electrically unconditioned
muscles after a vascular delay (median 3 weeks) demonstrated a variable
improvement in fatigue rates (initial flow 826 +/- 265 ml/min; time to no
forward flow, 2.5, 7.5, 7.5, 10, and 200 minutes). Four of six pouches that
received the benefit of long- term electrical muscle conditioning and a
vascular delay (N = 6) were able to generate flow for a 4 hour period, at
which time the experiment was terminated (initial flow 478 +/- 204 ml/min;
final flow 195 +/- 157 ml/min). After the 4 hour fatigue test was
completed, one electrically conditioned pouch was placed in series with the
heart and served as a counterpulsator. The initial volume of blood pumped
by the muscle pouch was 262 ml/min or 13.8% of cardiac output. After the
pouch had contracted at a rate of approximately 45 beats/min for 1 hour,
the volume of blood pumped was 178 ml/min, or 11% of cardiac output. In
three other animals a pouch was fashioned and then left in situ for a 1 to
3 week period before hydraulic testing. These pouches generated significant
initial flows (390 +/- 60 ml/min), which demonstrates the feasibility of
further study of permanent pouches. These results suggest that permanent
electrical muscle conditioning and perhaps a vascular collateral delay
might permit an auxiliary skeletal muscle- powered ventricle to assume a
portion of left ventricular function.
ARTICLES
Hydraulic pouches of canine latissimus dorsi. Potential for left ventricular assistance
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