Abstract
This study examined the ability of a skeletal muscle-powered assist ventricle (SMV) to augment cardiac output in ten dogs with pharmacologically induced heart failure under acute conditions. An SMV was surgically constructed in each dog by wrapping the untrained rectus abdominis muscle around a compressible pouch that was inserted into a left ventricular apex-to-aortic vascular conduit. The multiple motor nerves to the rectus muscle were then stimulated during ventricular diastole at a rate which equalled a ratio of 1∶2, 1∶3, or 1∶4 with the natural ventricular beat. There was an increased cardiac output during SMV assistance compared with preassistance values in all ten dogs at each stimulation ratio with a mean increase of 46±4 per cent with a ratio of 1∶2, 25±4 per cent with a ratio of 1∶3, and 31±7 per cent with a ratio of 1∶4 (p<0·01 for all values). The diastolic blood pressure and mean blood pressure were both increased (p<0·01 and p<0·05, respectively) during SMV stimulation at ratios of 1∶2 and 1∶3, but not 1∶4. We have shown that untrained rectus abdominis muscle, when used as the power supply for a SMV in an apico-aortic conduit, can temporarily augment cardiac output in dogs with pharmacologically induced heart failure.
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Acker, M. A., Hammond, R. L., Mannion, J. D., Salmon, S. andStephenson, L. W. (1987) Skeletal muscle as the potential power source for a cardiovascular pump; assessmentin vivo.Science,236, 324–327.
Armenti, F., Bitto, T., Macoviak, J. A., Kelly, A. M., Chase, N., Hoffman, B., Rubinstein, N. A., Sutton, M. S. J., Edmunds, L. H. andStephenson, L. W. (1984) Transformation of canine diaphragm to fatigue-resistant muscle by phrenic nerve stimulation.Surg. Forum,35, 258–260.
Bitto, T., Armenti, F. andHoffman, R. K. (1985) Time course of transformation of dog diaphragm muscle with continuous low frequency stimulation at 10 Hz and 2 Hz. Proc. 2nd Vienna Muscle Symp., 175–179.
Carpentier, A. andChachques, J. C. (1985) Myocardial substitution with a stimulated skeletal muscle: first successful clinical case.Lancet,8440, 1267.
Franciosa, J. A., Wilen, M., Zuseke, S. andCohm, J. N. (1983) Survival in men with severe chronic left ventricular failure due to either coronary heart disease or idiopathic dilated cardiomyopathy.Am. J. Cardiol.,51, 831–836.
Guyton, A. C., Jones, C. E. andColeman, T. G. (1973)Circulatory physiology: cardiac output and its regulation, 2nd edn. W. B. Saunders, Philadelphia.
Kantrowitz, A. andMcKinnon, W. M. P. (1959) The experimental use of the diaphragm as an auxiliary myocardium.Surg. Forum,9, 266–268.
Kusaba, E., Schraut, W., Sawatani, S., Jaron, D., Freed, P. andKantrowitz, A. (1973) A diaphragmatic graft for augmenting left ventricular function: a feasibility study.Trans. Am. Soc. Artif. Int. Organs,19, 251–257.
Macoviak, J. A. Stephenson, L. W., Alavi, A., Kelly, A. M. andEdmunds, L. H. (1981a) Effect of electrical stimulation on diaphragmatic muscle used to enlarge right ventricle.Surg.,90, 271–277.
Macoviak, J. A., Stephenson, L. W., Spielman, S., Greenspan, J. A. M., Likoff, M., Sutton, M. S. J., Reichek, N., Rashking, W. J. andEdmunds, L. H. (1981b) Replacement of ventricular myocardium with diaphragmatic skeletal muscle.J. Thorac. Cardiovasc. Surg.,81, 519–527.
Macoviak, J. A., Stephenson, L. W., Armenti, F., Kelly, A. M., Alari, A., Mackler, T., Cox, J., Palatianos, G. andEdmunds, L. H. (1982) Electrical conditioning ofin situ skeletal muscle for replacement of myocardium.J. Surg. Res.,32, 429–439.
Magovern, G. J., Park, S. B. andMagovern, G. J. Jr. (1986) Latissimus dorsi as a functioning synchronously paced muscle component in the repair of a left ventricular aneurysm.Ann. Thorac. Surg.,41, 116–121.
Mannion, J. D. andStephenson, L. W. (1985) Potential uses of skeletal muscle for myocardial assistance.Surg. Clinics North Am.,65, 679–687.
Mannion, J. D., Bitto, T., Hammond, R., Rubinstein, N. A. andStephenson, L. W. (1986a) Histochemical and fatigue characteristics of conditioned canine latissimus dorsi muscle.Circ. Res.,58, 298–304.
Mannion, J. D., Hammond, R. andStephenson, L. W. (1986b) Hydraulic pouches of canine latissimus dorsi.J. Thorac. Cardiovasc. Surg.,91, 534–544.
Nakamura, K. andGlenn, W. W. L. (1964) Graft of the diaphragm as a functioning substitute for the myocardium.Surg. Res.,4, 435–439.
Petrovsky, B. V. (1961) The use of diaphragm grafts for plastic operations in thoracic surgery.J. Thorac. Cardiovasc. Surg.,41, 348–355.
Salmons, S. andSreter, F. A. (1967) Significance of impulse activity in the transformation of skeletal muscle type.Nature,263, 30–34.
Salmons, S. andVrbova, G. (1969) The influence of activity on some contractile characteristics of mammalian fast and slow muscles.J. Physiol.,201, 535–549.
Salmons, S. andHenriksson, J. (1981) The adaptive response of skeletal muscle to increased use.Muscle & Nerve,4, 94–105.
Solis, E. andKaye, M. P. (1986) The registry of the International Society for Heart Transplantation: third official report, January–February 1986.Heart Transplant,5, (1), 2–5.
Spotnitz, H. M., Merker, C. andMalm, J. R. (1974) Applied physiology of the canine rectus abdominis: force-length curves correlated with functional characteristics of a rectus powered ‘ventricle’. Potential for cardiac assistance.Trans. Am. Soc. Artif. Int. Organs,20, 747–756.
Von Recum, A., Stulc, J. P., Hamada, O., Baba, H. andKantrowitz, A. (1977) Long-term stimulation of a diaphragm muscle pouch.Surg. Res.,23, 422–427.
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Badylak, S.F., Stevens, L., Janas, W. et al. Cardiac assistance with electrically stimulated skeletal muscle. Med. Biol. Eng. Comput. 27, 159–162 (1989). https://doi.org/10.1007/BF02446225
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DOI: https://doi.org/10.1007/BF02446225