Long-term ventricular wall actuation: can and should it be systematically explored?
Hearts fail because myocardial power fails. Assist, support, or replacement devices fail, at least in part, because their blood-contacting surfaces fail. Mechanical repowering of a failing heart might circumvent these difficulties by preserving a largely healthy endocardium while correcting the basic deficit, power. Any serious consideration of doing this though must confront some difficult requirements. Effective indefinite support must be coupled with preservation or restoration of valve competence, coronary flow, rapid low-impedance refilling and independent left and right pressures; the avoidance of wall coaptation; hardware that fits in the available space; and unless muscle powered, adaptability to a deliverable form of power. Despite earlier intense interest in acute mechanical devices and later empiric study of muscle wraps, little systematic methodical work has been done on elucidating and meeting these practical requirements. Concerted efforts toward developing research tools and techniques for their study and then finding mechanisms to meet them could well yield one or more effective modalities that circumvent a major obstacle to the indefinite mechanical treatment of heart failure.
Melvin
D B
DB
University of Cincinnati, Mechanical Circulatory Support Laboratory, Ohio, USA.
Schima
H
H
Losert
U M
UM
Wolner
E
E
D000818:Animals; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D003326:Coronary Circulation / Q000187:drug effects / Q000502:physiology*; D006333:Heart Failure / Q000188:drug therapy / Q000628:therapy*; D006351:Heart Valves / Q000187:drug effects / Q000502:physiology*; D006353:Heart-Assist Devices / Q000592:standards*; D006801:Humans; D009543:Nifedipine / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D011475:Prosthesis Failure; D016276:Ventricular Function
D002121:Calcium Channel Blockers; D009543:Nifedipine