Biologic Cardiac Assist: Performance Characteristics

  • J. S. Andersen
  • C. R. Bridges
  • W. A. Anderson
  • M. A. Acker
  • R. L. Hammond
  • F. DiMeoJr.
  • A. Chin
  • L. W. Stephenson


Currently, the patient with end-stage heart failure has few therapeutic options. These include cardiac transplantation, mechanical assist devices, and medical therapy only. Despite recent advances in all types of treatment, ideal therapy for the patient with a failing heart has yet to be offered. Such an option should provide independence from external mechanical attachments, allow for an immunocompetent host, and minimize effects associated with blood-surface interaction. Cardiac assist devices powered by skeletal muscle might meet these requirements.


Skeletal Muscle Latissimus Dorsi Stroke Work Latissimus Dorsi Muscle Burst Frequency 
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  1. 1.
    Acker MA, Hammond RL, Mannion JD, Salmons S, Stephenson LW (1986) An autologous biologic pump motor. J Thorac Cardiovasc Surg 92:733–746PubMedGoogle Scholar
  2. 2.
    Acker MA, Hammond RL, Mannion JD, Salmons S, Stephenson LW (1987) Skeletal muscle as a potential power source for a cardiovascular pump: assessment in vivo. Science 236:324–327PubMedCrossRefGoogle Scholar
  3. 3.
    Acker MA, Anderson WA, Hammond RL, Chin AJ, Buchanan JW, Morse CC, Kelly AM, Stephenson LW (1987) Skeletal muscle ventricles in circulation: one to eleven weeks’ experience. J Thorac Cardiovasc Surg 94:163–174PubMedGoogle Scholar
  4. 4.
    Mannion JD, Hammond RL, Stephenson LW (1986) Canine latissimus dorsi hydraulic pouches. Potential for left ventricular assistance. J Thorac Cardiovasc Surg 91:534–544PubMedGoogle Scholar
  5. 5.
    Mannion JD, Velchik MA, Acker M, Hammond R, Staum M, Alavi A, Duckett S, Stephenson LW (1986) Transmural blood flow of multi-layered latissimus dorsi skeletal muscle ventricles during circulatory assistance. Trans Am Soc Artif Intern Organs 32:454–460Google Scholar
  6. 6.
    Mannion JD, Acker MA, Hammond RL, Stephenson LW (1986) Four-hour circulatory assistance with canine skeletal muscle ventricles. Surg Forum 37:211–213Google Scholar
  7. 7.
    Mannion JD, Acker MA, Hammond RL, Faltemeyer W, Duckett S, Stephenson LW (1987) Power output of skeletal muscle ventricles in circulation: short-term studies. Circulation 76:155–162PubMedCrossRefGoogle Scholar
  8. 8.
    Leriche F, Fontaine R (1933) Essai experimental de traitement de certains infarctus du myocarde et de l’aneuvrisme du coeur par une greffe de muscle strie. Bull Soc Nat Chir 59:229–232Google Scholar
  9. 9.
    de Jesus FR (1931) Breves consideraciones sobre un case de herida penetrante del corazón. Bol Assoc Med PR 23:380–382Google Scholar
  10. 10.
    Beck CS (1935) A new blood supply to the heart by operation. Surg Gynecol Obstet 1:407–410Google Scholar
  11. 11.
    Petrovsky BV (1961) The use of the diaphragm grafts for plastic operations in thoracic surgery. J Thorac Cardiovasc Surg 41:348–355PubMedGoogle Scholar
  12. 12.
    Petrovsky BV (1966) Surgical treatment of cardiac aneurysms. J Cardiovasc Surg 2:87–91Google Scholar
  13. 13.
    Christ JE, Spira M (1982) Application of latissimus dorsi muscle to the heart. Ann Plast Surg 8(2): 118PubMedCrossRefGoogle Scholar
  14. 14.
    Sola OM, Dillard DH, Ivey TD, Haneda K, Itoh T, Thomas R (1985) Autotransplantation of skeletal muscle into myocardium. Circulation 71:341–348PubMedCrossRefGoogle Scholar
  15. 15.
    Schaff HV, Arnold PG, Reeder GS (1982) Late mediastinal infection and pseudoaneurysm following left ventricular aneurysmectomy repair utilizing pectoralis major muscle flap. J Thorac Cardiovasc Surg 84:912–916PubMedGoogle Scholar
  16. 16.
    Kantrowitz A, McKinnon W (1959) The experimental use of the diaphragm as an auxiliary myocardium. Surg Forum 9:266–268Google Scholar
  17. 17.
    Kantrowitz A (1960) Functioning autogenous muscle used experimentally as an auxiliary ventricle. Trans Am Soc Artif Intern Organs 6:305–310PubMedGoogle Scholar
  18. 18.
    Kusaba E, Schraut W, Sawatani S, Jaron D, Freed P, Kantrowitz A (1973) A diaphragmatic graft for augmenting left ventricular function: a feasibility study. Trans Am Soc Artif Intern Organs 19:251–257PubMedGoogle Scholar
  19. 19.
    Spotnitz HM, Merker C, Malm JR (1974) Applied physiology of the canine rectus abdominis. Trans Am Soc Artif Intern Organs 20:747–756PubMedGoogle Scholar
  20. 20.
    Drinkwater DC et al. (1980) Cardiac assist and myocardial repair with synchronously stimulated skeletal muscle. Surg Forum 31:271–273Google Scholar
  21. 21.
    Nakamura K, Glenn WWL (1964) Graft of the diaphragm as a functioning substitute for the myocardium. J Surg Res 4:435–39PubMedCrossRefGoogle Scholar
  22. 22.
    Termet H, Chalencon JL, Estour E, Gaillard P, Favre JP (1966) Transplantation sur le myocarde d’un muscle strie excite par pacemaker. Ann Chir Thor Cardiol 5:260–263Google Scholar
  23. 23.
    Shepherd MP (1969) Diaphragmatic muscle and cardiac surgery. Ann R Coll Surg Engl 45:212–231PubMedGoogle Scholar
  24. 24.
    Hume WI (1968) Construction of a functioning accessory myocardium. Trans Southern Surg Assoc 79:200–202Google Scholar
  25. 25.
    Phillips WL, Pallin S, Crostnopol P (1969) Diaphragmatic transplantation. Angiology 20:628–634PubMedCrossRefGoogle Scholar
  26. 26.
    Macoviak JA, Stephenson LW, Spielman S, Greenspan A, Likoff M, St. John-Sutton M, Riechek N, Rashkind WJ, Edmunds LH (1980) Electrophysiological and mechanical characteristics of diaphragmatic autograft used to enlarge the right ventricle. Surg Forum 31:270–271Google Scholar
  27. 27.
    Macoviak JA, Stephenson LW, Spielman S, Greenspan A, Likoff M, St. John-Sutton M, Riechek N, Rashkind WJ, Edmunds LH (1981) Replacement of ventricular myocardium with diaphragmatic skeletal muscle: acute studies. J Thorac Cardiovasc Surg 81:519–527PubMedGoogle Scholar
  28. 28.
    Macoviak JA, Stephenson LW, Alavi A, Kelly AM, Edmunds LH (1981) Effects of electrical stimulation on diaphragmatic muscle used to enlarge the right ventricle. Surgery 90:271–277PubMedGoogle Scholar
  29. 29.
    Macovial JA, Stephenson LW, Kelly A, Likoff M, Reichek N, Edmunds LH (1981) Partial replacement of the right ventricle with a synchronously contracting diaphragmatic skeletal muscle autograft. Proceedings of II Meeting of the International Society for Artificial Organs 1981; 5 [Suppl 1]:550–555Google Scholar
  30. 30.
    Carpentier A, Chachques JC (1985) Myocardial substitute with a stimulated skeletal muscle: first successful clinical case. Lancet 1:1267PubMedCrossRefGoogle Scholar
  31. 31.
    Magovern GJ, Park SB, Magovern GJ, Benckart DH, Tullis G, Rozar E, Kao R, Christlieb I (1986) Latissimus dorsi as a functioning synchronously paced muscle component in the repair of a left ventricular aneurysm. Ann Thorac Surg 41:116PubMedCrossRefGoogle Scholar
  32. 32.
    Anderson WA, Andersen JS, Acker MA, Hammond RL, Chin AJ, Douglas PS, Salmons S, Stephenson LW (to be published) Skeletal muscle applied to the heart: a word of caution. CirculationGoogle Scholar
  33. 33.
    Kusserow BK, Clapp JF (1964) A small ventricle-type pump for prolonged perfusions: construction and initial studies including attempts to power a pump biologically with skeletal muscle. Trans Am Soc Artif Intern Organs 8:74–78Google Scholar
  34. 34.
    Vachon BR, Kunov H, Zingg W (1975) Mechanical properties of diaphragm muscles in dogs. Med Biol Eng 13:252–260PubMedCrossRefGoogle Scholar
  35. 35.
    von Recum A, Stulc JP, Hamada O, Baba H, Kantrowitz A (1977) Long-term stimulation of a diaphragm muscle pouch. J Surg Res 23:422–427CrossRefGoogle Scholar
  36. 36.
    Juffe A, Ricoy JR, Marquez J, Castillo-Olivares JL, Figuera D (1978) Cardialization: a new source of energy for circulatory assistance. Vasc Surg 12:10–17Google Scholar
  37. 37.
    Mommaerts WFHM (1982) Heart muscle. In: Fishman AP, Richards DW (eds) Circulation of the blood, man and ideas. American Phyiological Society, Bethesda, pp 127–198Google Scholar
  38. 38.
    Adams R, Schwartz A (1980) Comparative mechanisms for contraction of cardiac and skeletal muscle. Chest 78:123–139PubMedGoogle Scholar
  39. 39.
    Dewar ML, Drinkwater DC, Wittnich C, Chiu RCJ (1984) Synchronously stimulated skeletal muscle graft for myocardial repair. J Thorac Cardiovasc Surg 87:325–331PubMedGoogle Scholar
  40. 40.
    Chiu RCJ, Walsh GL, Dewar ML, De Simon JH, Khalafalla AS (1987) Implantable extra- aortic balloon assist powered by transformed fatigue-resistant skeletal muscle. J Thorac Cardiovasc Surg 94:694–701PubMedGoogle Scholar
  41. 41.
    Chachques J, Grandjean P, Vasseur B, Hero M, Perier P, Bourgeois I, Fardeau M, Carpentier A (1985) Electrophysiological conditioning of latissimus dorsi muscle flap for myocardial assistance. In: Nose Y, Kjellstrand C, Ivanovich P (eds) Progress in artificial organs. ISAO Press, Cleveland, pp 409–12Google Scholar
  42. 42.
    Mannion JD, Velchik M, Alavi A, Stephenson LW (1985) Blood flow in conditioned and unconditioned latissimus dorsi muscle (abstract). Second Vienna Muscle Symposium, 1985, p 28Google Scholar
  43. 43.
    Glenn W, Phelps M (1985) Diaphragm pacing by electrical stimulation of the phrenic nerve. Neurosurgery 17:974–984PubMedCrossRefGoogle Scholar
  44. 44.
    Ciesielski TE, Fukuda Y, Glenn W, Gorfien J, Jeffery K, Hogan JF (1983) Response of the diaphragm muscle to electrical stimulation of the phrenic nerve. J Neurosurg 58:92–100PubMedCrossRefGoogle Scholar
  45. 45.
    Kim JH, Manuelidis EE, Glenn W, Fukuda Y, Cole DS, Hogan JF (1983) Light- and electron-microscopic studies of phrenic nerves after long-term electrical stimulation. J Neurosurg 58:84–91PubMedCrossRefGoogle Scholar
  46. 46.
    Buller JC, Eccles JC, Eccles RM (1960) Differentiation of fast and slow muscles in the cat hind limb. J Physiol (Lond) 150:399–416Google Scholar
  47. 47.
    Buller JC, Eccles JC, Eccles RM (1960) Interactions between motor neurons and muscles in respect of the characteristic speeds of their responses. J Phyiol (Lond) 150:417–139Google Scholar
  48. 48.
    Salmons S, Vrbova G (1969) The influence of activity on some contractile characteristics of mammalian fast and slow muscles. J Physiol (Lond) 210:535–549Google Scholar
  49. 49.
    Chi et al. (1986) Chronic stimulation of mammalian muscle: enzyme changes in individual fibers. Am J Physiol C633–C642Google Scholar
  50. 50.
    Macoviak JA, Stephenson LW, Armenti F, Kelly AM, Alavi A, Mackler T, Cox J, Palatianois GM, Edmunds LH (1982) Electrical conditioning of in situ skeletal muscle for replacement of myocardium. J Surg Res 32:429–439PubMedCrossRefGoogle Scholar
  51. 51.
    Armenti FR, Bitto T, Macoviak JA, Kelly AM, Chase CT, Hoffman BK, Rubinstein NA, St. John-Sutton M, Edmunds LH, Stephenson LW (1984) Transformation of skeletal muscle for cardiac replacement. Surg Forum 35:258–260Google Scholar
  52. 52.
    Bitto T, Mannion J, Hammond R, Cox J, Yamashita J, Duckett SW, Salmons S, Stephenson LW (1985) Preparation of fatigue-resistant diaphragmatic muscle grafts for myocardial replacement. In: Nose Y, Kjellstrand C, Ivanovich P (eds) Progress in artificial organs. ISAO Press, Cleveland, pp 441–446Google Scholar
  53. 53.
    Mannion JD, Bitto T, Hammond R, Rubinstein N, Stephenson LW (1986) Histochemical fatigue characteristics of conditioned canine latissimus dorsi muscle. Circ Res 58:298–304PubMedGoogle Scholar
  54. 54.
    Mannion JD, Acker MA, Hammond RL, Stephenson LW, Khalafalla A, Henriksson J, Salmons S (in press) Chronic burst stimulation of canine latissimus dorsi muscle: a further step towards the use of skeletal muscle for cardiac augmentation. Proceedings, Padova muscle symposium, 1986Google Scholar
  55. 55.
    Acker MA, Mannion JD, Brown WE, Salmons S, Henriksson J, Bitto T, Gale DR, Hammond R, Stephenson LW (1987) Canine diaphragm muscle after one year of continuous electrical stimulation: its potential as a myocardial substitute. J Appl Physiol 62:1264–1270PubMedGoogle Scholar
  56. 56.
    Clark BJ, Acker MA, Subramanian H, McCully K, Hammond B, Salmons S, Chance B, Stephenson LW (1988) In vivo P-NMR spectroscopy of electrically conditioned skeletal muscle. Am J Physiol 254:C-258–266Google Scholar
  57. 57.
    Acker MA, Anderson WA, Hammond RL, Di Meo F, McCullum J, Staum M, Velchik M, Brown WE, Gale D, Salmons S, Stephenson LW (1987) Oxygen consumption of fatigue-resistant muscle. J Thorac Cardiovasc Surg 94:702–709PubMedGoogle Scholar
  58. 58.
    Stevens L, Brown J (1986) Can noncardiac muscle provide useful cardiac assistance? Am Surg 52:423–27PubMedGoogle Scholar
  59. 59.
    Neilson IR, Brister SJ, Khalafalla AS, Chiu RCJ (1985) Left ventricular assistance in dogs using a skeletal muscle-powered device for diastolic augmentation. J Heart Transplant 4:343–347PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1989

Authors and Affiliations

  • J. S. Andersen
  • C. R. Bridges
  • W. A. Anderson
  • M. A. Acker
  • R. L. Hammond
  • F. DiMeoJr.
  • A. Chin
  • L. W. Stephenson

There are no affiliations available

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