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Muscle‐ and Pneumatic‐Powered Counterpulsating LVADs: A Pilot Study
Author(s) -
Wilde J.C.H.,
Ioon J.,
Bishop N.D.,
Shelton A. Dehlavi,
Marten C.,
Kolff W.J.,
Stephenson L.,
Baciewicz F.,
Nakajima H.,
Thomas G.,
Hammond B.
Publication year - 1994
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/j.1525-1594.1994.tb02182.x
Subject(s) - cardiomyoplasty , medicine , latissimus dorsi muscle , ventricle , peristaltic pump , cardiology , surgery , heart failure , mechanical engineering , engineering
There is a worldwide interest in supporting the failing heart with a skeletal muscle by either wrapping it around the natural heart (dynamic cardiomyoplasty) or by constructing a skeletal muscle ventricle (SMV) used for counterpulsation. Conventional cardiomyoplasty in many clinics carries an operative mortality rate of 15–20% partly because it requires 6 weeks to train the muscle to contract continually. A flexible, pear‐shaped blood pump with an inflatable air chamber was designed and made around which a muscle can be wrapped. The advantage of our design is that it can also be driven by pneumatic power, immediately supporting the circulation of a seriously ill patient while that patient is still on the operating table. After a period of time to allow for revascularization and the subsequent training of the muscle, the external pneumatic power can be gradually discontinued. Then the assisted patient becomes tether‐free. If, at any time, the muscle power fails, the pneumatic‐powered mechanism can be reactivated. In the preferred approach, the blood pump is connected to the aorta for diastolic counterpulsation. A muscle can either be wrapped around the blood pump directly, or around one of two separate muscle pouches connected to the blood pump. To facilitate surgery, a large pouch is inserted under the musculus latissimus dorsi, which is connected to a blood pump. When stimulated, the muscle will contract over the pouch compressing it and providing power to the blood pump. If it is found that the pressure generated in the pouch cannot meet the aortic blood pressure, it can be augmented by using a pressure amplifier. An amplifier has been designed and constructed that can be incorporated into the pouch under the musculus latissimus dorsi. Once again, an external pneumatic power source could be used to drive this system while the muscle is being trained. We can make our pouches and pumps available to surgeons for experimental work if they are willing to test them.