In Vivo Performance of a Muscle-Powered Drive System for Implantable Blood Pumps

Artificial Muscles and Soft Robotic Devices for Treatment of End-Stage Heart Failure

Medical soft robotics constitutes a rapidly developing field in the treatment of cardiovascular diseases, with a promising future for millions of patients suffering from heart failure worldwide. Herein, the present state and future direction of artificial muscle-based soft robotic biomedical devices in supporting the inotropic function of the heart are reviewed, focusing on the emerging electrothermally artificial heart muscles (AHMs). Artificial muscle powered soft robotic devices can mimic the action of complex biological systems such as heart compression and twisting. These artificial muscles possess the ability to undergo complex deformations, aiding cardiac function while maintaining a limited weight and use of space. Two very promising candidates for artificial muscles are electrothermally actuated AHMs and biohybrid actuators using living cells or tissue embedded with artificial structures. Electrothermally actuated AHMs have demonstrated superior force generation while creating the prospect for fully soft robotic actuated ventricular assist devices. This review will critically analyze the limitations of currently available devices and discuss opportunities and directions for future research. Last, the properties of the cardiac muscle are reviewed and compared with those of different materials suitable for mechanical cardiac compression.

Current State and Future Perspectives of Energy Sources for Totally Implantable Cardiac Devices

There is a large population of patients with end-stage congestive heart failure who cannot be treated by means of conventional cardiac surgery, cardiac transplantation, or chronic catecholamine infusions. Implantable cardiac devices, many designated as destination therapy, have revolutionized patient care and outcomes, although infection and complications related to external power sources or routine battery exchange remain a substantial risk. Complications from repeat battery replacement, power failure, and infections ultimately endanger the original objectives of implantable biomedical device therapy - eliminating the intended patient autonomy, affecting patient quality of life and survival. We sought to review the limitations of current cardiac biomedical device energy sources and discuss the current state and trends of future potential energy sources in pursuit of a lifelong fully implantable biomedical device.

Potential mechanisms for muscle-powered cardiac support

Biomechanical actuation of an implanted ventricular assist device (VAD) is an attractive means of providing long-term circulatory support. Studies show that energy from electrically stimulated skeletal muscle can, in principle, be used to provide tether-free cardiac assistance without the need for percutaneous drivelines or bulky energy transmission hardware. A mechanical prosthesis designed to harness the contractile power of in situ skeletal muscle has been developed in this laboratory that collects energy from the latissimus dorsi muscle and transmits it in the form of hydraulic power. In order to use this technique to pump blood however, a practical means to deliver this energy to the bloodstream must be devised. Presented here are six prospective mechanisms designed to accomplish this task, five of which also eliminate blood contacting surfaces that often lead to thromboembolic complications in chronic VAD patients.

Design Improvements and In Vitro Testing of an Implantable Muscle Energy Converter for Powering Pulsatile Cardiac Assist Devices

Harnessing skeletal muscle for circulatory support would improve on current blood pump technologies by eliminating infection-prone drivelines and cumbersome transcutaneous energy transmission systems. Toward that end, we have built and tested an implantable muscle energy converter (MEC) designed to transmit the contractile energy of the latissimus dorsi muscle in hydraulic form. The MEC weighs less than 300 g and comprises a metallic bellows formed from AM350 stainless steel actuated by a rotary cam (440C) attached to a titanium rocker arm (Ti–6Al–4V). The rocker arm is fixed to the humeral insertion of the muscle via a looped artificial tendon developed specifically for this purpose. The device housing (Ti–6Al–4V) is anchored to the ribcage using a perforated mounting ring and a wire suture. Lessons learned through seven previous design iterations have produced an eighth-generation pump with excellent durability, energy transfer efficiency, anatomic fit, and tissue interface characteristics. This report describes recent improvements in MEC design and summarizes results from in silico and in vitro testing. Long-term implant studies will be needed to confirm these findings prior to clinical testing.

In vivo demonstration of a self-sustaining, implantable, stimulated-muscle-powered piezoelectric generator prototype

An implantable, stimulated-muscle-powered piezoelectric active energy harvesting generator was previously designed to exploit the fact that the mechanical output power of muscle is substantially greater than the electrical power necessary to stimulate the muscle's motor nerve. We reduced to practice the concept by building a prototype generator and stimulator. We demonstrated its feasibility in vivo, using rabbit quadriceps to drive the generator. The generated power was sufficient for self-sustaining operation of the stimulator and additional harnessed power was dissipated through a load resistor. The prototype generator was developed and the power generating capabilities were tested with a mechanical muscle analog. In vivo generated power matched the mechanical muscle analog, verifying its usefulness as a test-bed for generator development. Generator output power was dependent on the muscle stimulation parameters. Simulations and in vivo testing demonstrated that for a fixed number of stimuli/minute, two stimuli applied at a high frequency generated greater power than single stimuli or tetanic contractions. Larger muscles and circuitry improvements are expected to increase available power. An implanted, self-replenishing power source has the potential to augment implanted battery or transcutaneously powered electronic medical devices.