Skeletal Muscle Ventricles with Efferent Valved Homograft

Skeletal muscle ventricles (SMVs) were constructed from the latissimus dorsi muscle in seven beagles. Following 3 weeks of vascular delay and 6 weeks of electrical conditioning, the SMVs were connected in series with the thoracic aorta using a valved aortic homograft for the efferent limb. The SMVs were stimulated to contract synchronously during diastole. Effective aortic diastolic counterpulsation was achieved in all dogs, with an average 24.2%± 15.3% improvement in diastolic pressure. In two animals surviving beyond 3 months, increase in SMV function was noted over time. Appropriate aortic homograft valve function was documented by echocardiogram. Acute reversible heart failure was induced with propranolol in one dog alive after 126 days. A 61.3% reduction in cardiac output and a 37.6% reduction in mean arterial blood pressure were achieved. During profound low cardiac output, SMV stimulation with 33 Hz and 50 Hz improved cardiac output by 16.9% and 17.8%, improved the tension time index by 14.9% and 16.1%, and improved the endocardial viability ratio by 34.1% and 34.1%, respectively. These results again demonstrate the long-term effectiveness of SMVs as aortic counterpulsators. A valve in the efferent limb of the SMV system functions appropriately over time and may improve the efficiency of the system.