Use of the anaerobic threshold for evaluating various total artificial heart control algorithms in calves

Hemodynamic and metabolic changes during exercise in calves with total artificial hearts of different sizes yet similar output

To evaluate the effects of downsizing of the total artificial heart (TAH), we compared the anaerobic threshold (AT) values in calves with two different types of TAH (Cleveland Clinic-Nimbus TAH and the downsized MagScrew TAH). Exercise studies were performed using a treadmill in 12 calves. During the exercise, parameters to obtain the AT were measured. To evaluate the determinants of the AT, a linear regression analysis was performed between AT and potential variables. AT values from 29 studies revealed no significant differences between the two different TAHs, with no significant differences in hemodynamic or oxygen metabolic parameters. AT values correlated well with pump flow/body weight (Q) multiplied by the hemoglobin level, regardless of the TAH used. In conclusion, downsizing of the original TAH design did not reduce AT without any significant differences in hemodynamic or oxygen metabolic parameters during exercise in calves.

Treadmill exercise in calves implanted with the AbioCor replacement heart

The aim of this study was to evaluate the function of the AbioCor artificial heart implanted in calves that underwent treadmill exercise testing and to investigate the cardiovascular and metabolic responses during exercise. Six calves were implanted with the AbioCor. One week after surgery, exercise training was undertaken and animals were put on a treadmill at a speed of 0.5-1.0 mph, with the AbioCor operating at the maximum heart rate of 150 beats per minute. During exercise, the left and right atrial pressures were significantly increased (p < 0.05). Oxygen consumption was significantly elevated (p < 0.05). Lactate levels did not significantly increase (p > 0.05). The index of metabolic adequacy remained higher than 2.0, indicating that there was no substantial transition to anaerobic metabolism during exercise. There was an increased extraction of oxygen during exercise to meet the increased energy demands. Our study demonstrated that animals implanted with the AbioCor heart were able to maintain aerobic metabolism during low levels of exercise testing.

In vitro and in vivo validation tests for total artificial heart

Properly planned in vitro and in vivo studies are mandatory to validate blood pump performance. However, standard procedures for in vitro and in vivo tests of total artificial heart (TAH) performance still do not exist. At Baylor College of Medicine, standard tests procedures for performance validation of the totally implantable TAH have been established. In this paper, these in vitro tests protocols (performance mapping tests, accelerated endurance test, hemolysis test, flow visualization tests, etc.) are described as well as in vivo test procedures (TAH implantation procedure, including surgical technique, postoperative management and tests, etc.). In addition, pathological protocols are presented. In our experience, these procedures are very simple, easy to perform, and inexpensive. These protocols are proposed as standard in vitro and in vivo tests for a TAH.

Control of the total artificial heart: new aspects in human versus animal experience

Control strategies for total artificial heart application have generally been based on experience with healthy animals. Human patients in a bad state of health who have impaired organ functions and who are subjected to intensive care procedures can develop atypical hemodynamic behavior. In these patients, both unstable and hyperstable behavior of the vascular resistance were observed. Therefore, regulation of cardiac output (CO) by pressure parameters only was avoided and CO was adjusted to obtain an appropriate O2-utilization (O2U). Intending to keep the O2U within ranges of 20-25%, we obtained cardiac indexes between 3.3 and 4.4 L/m2/min (CO 6-8 L/min), which is higher than other cardiac indexes reported. A CO of 10.5 L/min was even necessary to obtain an O2U of 30% in a septic patient. This strategy caused a stable driving management and led to a rapid hemodynamic stabilization and general improvement of the patients' condition. Results indicate that it is also very important to monitor metabolic parameters for appropriate driver adjustment as well, especially in the early postoperative phase, and that O2-U is a sensitive and useful parameter for this purpose.