Sustained skeletal muscle power for cardiac assist devices: implications of metabolic constraints.

A device to harness power from skeletal muscle contracting in a linear configuration is under development. This application requires a sustained level of power that is dependent upon muscle mechanics and metabolic properties. A biomechanical muscle model and a metabolic model constructed from experimental data were used to predict maximum power available in a sustainable region of loading and stimulation conditions. Latissimus dorsi (LD) of four goats were evaluated in vivo after a 10 week in situ conditioning protocol with an implanted Telectronics myostimulator. The LD insertion was reconnected to a hydraulic loading system, allowing isometric and isotonic contractions for biomechanical characterization. Metabolic utilization was measured by a thermister based myothermic technique. Brief fatigue tests of working isotonic contractions revealed stimulation conditions associated with sustained power. The results show metabolic utilization was dependent on contraction duration, rate, force, and stroke. The region of sustainable contractions was found for a range of durations of 0.1 to 0.6 sec and rates of 10 to 120 bpm. The boundary for the sustainable power region was well approximated by a constant value of metabolic utilization. A constant duty cycle (contraction to cycle duration ratio) also approximated the sustained power but differed by as much as 30% during the shorter contraction durations. The results demonstrate that a mechanical muscle model can predict maximum sustained power when the operating conditions are constrained to a sustainable range determined by a metabolic model. Furthermore, metabolic constraints influence the optimum conditions for sustained power needed in the design of skeletal muscle powered assist devices.

Less invasive Thoratec LVAD insertion: a surgical technique.

Left Ventricular Assist Device (LVAD) implantation is historically a complicated, invasive operation performed on critically ill patients and is often associated with bleeding and multiorgan morbidity. The purpose of this investigation was to devise an LVAD insertion technique, utilizing the concepts of less invasive cardiac surgery, that would be a less complicated operation, with low morbidity, and still meet all the goals of the standard procedure. We describe the technical details of a "less invasive" LVAD implantation.

Relative metabolic utilization of in situ rabbit soleus muscle: thermistor-based measurements and model.

Electrically conditioned skeletal muscle can provide the continuous power source for cardiac assistance devices. Optimization of the available sustained power from in vivo skeletal muscle requires knowledge of its metabolic utilization and constraints. A thermistor-based technique has been developed to measure temperature changes and to provide a relative estimate for metabolic utilization of in situ rabbit soleus muscle. The relative thermistor response, active tension and muscle displacement were measured during cyclic isometric and isotonic contractions across a range of muscle tensions and contraction durations. The thermistor response demonstrated linear relationships versus both contraction duration at a fixed muscle length and active tension at a fixed contraction duration (r(2)=0.90+/-0.14 and 0.70+/-0.21, respectively; means +/- s.d.). A multiple linear regression model was developed to predict normalized thermistor response, DeltaT, across a range of conditions. Significant model variables were identified using a backward stepwise regression procedure. The relationships for the in situ muscles were qualitatively similar to those reported for mammalian in vitro muscle fiber preparations. The model had the form DeltaT=C+at(c)F+bW, where the constant C, and coefficients for the contraction duration t(c) (ms), normalized active tension F and normalized net work W were C=-1.00 (P<0.001), a=5.97 (P<0.001) and b=2.12 (P<0.001).

Evaluation of a skeletal muscle energy convertor in a chronic animal model.

A device is under development for powering cardiac assist devices with skeletal muscle contracting in a linear configuration by converting muscle work to hydraulic energy. Prototype devices are being implanted in goats to study device performance and associated muscle mechanics. Percutaneous hydraulic lines provide the means to control muscle load and evaluate muscle performance during an electrical conditioning protocol. Chronic implant durations ranged from 36 to 87 days in 7 goats. The latissimus dorsi muscle (LDM) insertion was reconnected to the device with a tendon loop. A sternal plate attached with bone screws, and a rib clamp secured the device. A new modular sternal mount design was implemented to eliminate plate loosening that complicated early implants. Extensive bone remodeling around the rib clamp was observed. The tendon attachment demonstrated sufficient initial strength; however, in five implants, efforts to repair the tendon were required. Device encapsulation was observed, but the device continued to cycle freely and no tethering adhesions to the device were found. Interactions between the capsule wall and LDM seemed to limit LDM movement in some cases. Development of a long-term animal model for energy convertor evaluations is an important step toward skeletal muscle powered cardiac assist.