Use of Gloves to Examine Intermittent Palm Cooling's Impact on Rowing Ergometry.

ABSTRACT: O'Brien, IT, Kozerski, AE, Gray, WD, Chen, L, Vargas, LJ, McEnroe, CB, Vanhoover, AC, King, KM, Pantalos, GM, and Caruso, JF. Use of gloves to examine intermittent palm cooling's impact on rowing ergometry. J Strength Cond Res 35(4): 931-940, 2021-The aim of this study was to examine the use of gloves on intermittent palm cooling's impact on rowing ergometry workouts. Our methods had subjects (n = 34) complete 3 rowing ergometer workouts of up to 8 2-minute stages separated by 45- or 60-second rests. They were randomized to one of the following treatments per workout: no palm cooling (NoPC), intermittent palm cooling as they rowed (PCex), or intermittent palm cooling as they rowed and post-exercise (PCex&post). Palm cooling entailed intermittent cold (initial temperature: 8.1° C) application and totaled 10 (PCex) and 20 (PCex&post) minutes, respectively. Workouts began with 8 minutes of rest after which pre-exercise data were obtained, followed by a ten-minute warm-up and the workout, and 20 minutes of post-exercise recovery. Numerous physiological and performance variables were collected before, during, and after workouts, and each was analyzed with either a two- or three-way analysis of variance. Our results include, with a 0.05 alpha and a simple effects post hoc, the distance rowed analysis produced a significant workout effect with PCex, PCex&post > NoPC. There were also significant interworkout differences for heart rate (HR) (NoPC > PCex) and blood lactate concentration (NoPC > PCex, PCex&post). We conclude that lower HRs and blood lactate concentrations from intermittent cooling caused subjects to experience less fatigue during those workouts and enabled more work to be performed. Continued research should identify optimal cooling characteristics to expedite body heat removal. Practical applications suggest that intermittent palm cooling administered with gloves enhance performance by abating physiological markers of fatigue.

Ergogenic and Physiological Outcomes Derived From a Novel Skin Cooling Device.

ABSTRACT: Gray, WD, Jett, DM, Cocco, AR, Vanhoover, AC, Colborn, CE, Pantalos, GM, Stumbo, J, Quesada, PM, and Caruso, JF. Ergogenic and physiological outcomes derived from a novel skin cooling device. J Strength Cond Res 35(2): 391-403, 2021-Our study's purpose assessed a cooling headband's ergogenic and physiological impacts. Subjects (15 women and 13 men) completed six visits; the final 3 entailed rowing workouts with the following treatment conditions: no head cooling (NoHC), intermittent head cooling during exercise (HCex), and intermittent head cooling during exercise and post-exercise recovery (HCex&post). Data collection occurred at the following times (a) pre-exercise and post-warm-up, (b) between stages of up to eight 2-minute bouts, and (c) at 5, 10, 15, and 20 minutes post-exercise. In addition to distance rowed, thermal, cardiovascular, perceptual, and metabolic measurements were obtained. Results included a small yet significant intertreatment difference (HCex, HCex&post > NoHC) for distance rowed. Our cardiovascular and metabolic indices exhibited sex and time differences but likely did not contribute to the ergogenic effect. Yet, left hand temperatures (LHT) exhibited significant 2-way and 3-way interactions that were the likely source of the ergogenic effect. Auditory canal temperature (AUDT) results suggest the head is sensitive to heat increases, yet LHT data show headband use evoked significantly greater temperature increases at the hand's palmar surface, indicative of heat transfer. We conclude, and our practical applications suggest, the headband's ergogenic effect was manifested by cold-induced vasodilation at the hand's palmar surface, rather than heat losses through the head.

Load-Power Relationships for High-Speed Knee Extension Exercise.

Chen, L, Davison, SW, Selimovic, EA, Mueller, RE, Beatty, SR, Carter, KA, Parmar, PJ, Symons, TB, Pantalos, GM, and Caruso, JF. Load-power relationships for high-speed knee extension exercise. J Strength Cond Res 33(6): 1480-1487, 2019-Seventy subjects did 4 knee extensor workouts with their left legs to assess load-power relationships produced on a high-speed trainer (HST; Newnan, GA, USA). Each workout is composed of 4 sets done on the HST at a different load (1, 4.4, 6.7, 9 kg). A Latin Squares Design determined load sequence per workout. Average power (AP) and peak power (PP) and those same values normalized to body mass (BM) and fat-free mass (AP/BM, PP/BM, AP/FFM, PP/FFM) were each analyzed with 2 (gender) × 4 (load) analysis of variances, with repeated measures for load. We assessed relationships between normalized loads and AP and PP values with correlation coefficients. Average power results revealed a significant interaction, with men > women at 9 kg. Peak power/body mass also yielded an interaction, with women > men at 6.7 and 9 kg. Average power/fat-free mass and PP/FFM each produced interactions, with women > men at 4.4, 6.7, and 9 kg. Correlation coefficients showed significant (r = 0.80-0.82) relationships between normalized loads and AP and PP values. In conclusion, the very low inertial resistance to initiate each repetition on this novel device may in part explain our PP/BM, AP/FFM, PP/FFM results, in which higher values were achieved by women. Our practical applications imply that the low inertial resistance for HST repetitions negates male size and strength advantages typically seen when power is measured.

Extracorporeal membrane oxygenation versus counterpulsatile, pulsatile, and continuous left ventricular unloading for pediatric mechanical circulatory support.

OBJECTIVES: Despite progress with adult ventricular assist devices, limited options exist to support pediatric patients with life-threatening heart disease. Extracorporeal membrane oxygenation remains the clinical standard. To characterize (patho)physiologic responses to different modes of mechanical unloading of the failing pediatric heart, extracorporeal membrane oxygenation was compared to intra-aortic balloon pump, pulsatile-flow ventricular assist device, or continuous-flow ventricular assist device support in a pediatric heart failure model. DESIGN: Experimental. SETTING: Large animal laboratory operating room. SUBJECTS: Yorkshire piglets (n = 47; 11.7 ± 2.6 kg). INTERVENTIONS: In piglets with coronary ligation-induced cardiac dysfunction, mechanical circulatory support devices were implanted and studied during maximum support. MEASUREMENTS AND MAIN RESULTS: Left ventricular, right ventricular, coronary, carotid, systemic arterial, and pulmonary arterial hemodynamics were measured with pressure and flow transducers. Myocardial oxygen consumption and total-body oxygen consumption were calculated from arterial, venous, and coronary sinus blood sampling. Blood flow was measured in 17 organs with microspheres. Paired Student t tests compared baseline and heart failure conditions. One-way repeated-measures analysis of variance compared heart failure, device support mode(s), and extracorporeal membrane oxygenation. Statistically significant (p < 0.05) findings included 1) an improved left ventricular blood supply/demand ratio during pulsatile-flow ventricular assist device, continuous-flow ventricular assist device, and extracorporeal membrane oxygenation but not intra-aortic balloon pump support, 2) an improved global myocardial blood supply/demand ratio during pulsatile-flow ventricular assist device and continuous-flow ventricular assist device but not intra-aortic balloon pump or extracorporeal membrane oxygenation support, and 3) diminished pulsatility during extracorporeal membrane oxygenation and continuous-flow ventricular assist device but not intra-aortic balloon pump and pulsatile-flow ventricular assist device support. A profile of systems-based responses was established for each type of support. CONCLUSIONS: Each type of pediatric ventricular assist device provided hemodynamic support by unloading the heart with a different mechanism that created a unique profile of physiological changes. These data contribute novel, clinically relevant insight into pediatric mechanical circulatory support and establish an important resource for pediatric device development and patient selection.

A hermetically sealed, fluid-filled surgical enclosure for microgravity.

INTRODUCTION: Expeditionary spaceflight is fraught with significant risks to human health, including trauma and other emergency medical events. To address several of the basic challenges of surgical care in reduced gravity, we are developing the Aqueous Immersion Surgical System (AISS), an optically clear enclosure pressurized by a fluid medium. The AISS is designed to prevent contamination of the spacecraft with blood and tissue debris, reduce intraoperative blood loss, and maintain visualization of the operative field. METHODS: An early prototype of the AISS was tested in reduced gravity during parabolic flight. A clear, aqueous field was created in a watertight chamber containing a mock vascular network. Hemorrhage was simulated by severing several of the analogue vessels. Experiments were performed to evaluate the benefits of surrounding a surgical cavity with fluid medium, as compared to an air environment, with respect to maintaining a clear view and achieving hemostasis. RESULTS: Qualitative evaluation of audio and video recorded during parabolic flight confirm AISS capacity to maintain visualization of the surgical field during a hemorrhage situation and staunch bleeding by raising interchamber pressure. DISCUSSION: Evaluation of the AISS in reduced gravity corroborates observations in the literature regarding the difficulty in maintaining visualization of the surgical field when performing procedures in an air environment. By immersing the surgical field in fluid we were able to apply suction directly to the hemorrhage and also achieve hemostasis.

Intravenous Fluid Resuscitation Capabilities in Simulated Reduced Gravity.

BACKGROUND: Critical care for exploration space missions may require intravenous (IV) fluid resuscitation therapy. Resource constraints may limit availability of standard, Earth-based infusion technologies. The effect of variable acceleration on infusion flow rates using simple fluid resuscitation supplies was investigated.METHODS: Infusions of water or blood analog (40% glycerol) from a 1 L IV bag were performed using pressure bag augmentation at 0, 150, or 300 mmHg. The solution bag rested on an adjustable mount, configured to different heights to simulate relevant gravitational accelerations (1 G, Martian G, lunar G, and 0 G). The bag emptied through an IV line with a 14- or 20-gauge angiocath into a 3-mmHg venous pressure reservoir. Flow rates were measured using an in-line flow probe. Three determinations were made for each test condition.RESULTS: Temporal flow rate data for all test conditions displayed one-phase exponential decay. At 300 mmHg pressurization, maximum infusion rates ranged from 92-222 mL ⋅ min-1 for water and from 21-49 mL ⋅ min-1 for blood analog. All reduced gravity conditions had significantly longer infusion times in comparison to 1 G for both test solutions.DISCUSSION: Reduced acceleration significantly altered flow rates and infusion times for fluid resuscitation. Fluid resuscitation protocols specify a desired volume to infuse for a target time (e.g., 20-30 mL ⋅ min-1 for a 75-kg adult). This data demonstrates that this protocol parameter can be achieved with infusion pressure bag augmentation alone and provides information for the refinement of fluid resuscitation protocols for exploration space missions.Pantalos GM, Heidel JS, Jain IM, Warner SE, Barefoot TL, Baker RO, Hailey M. Intravenous fluid resuscitation capabilities in simulated reduced gravity. Aerosp Med Hum Perform. 2023; 94(8):596-603.

Intraaortic balloon pump timing discrepancies in adult patients.

The objective of this clinical study was to quantify the incidence and magnitude of intraaortic balloon pump (IABP) inflation and deflation landmark discrepancies associated with the IABP catheter arterial pressure waveform. Cardiac surgery patients with an IABP inserted prior to surgery were recruited. Following cardiac exposure, a high-fidelity pressure catheter was inserted into the aortic root for digital recording. The radial artery pressure signal was simultaneously recorded from the patient monitor along with the arterial pressure and electrocardiogram waveforms from the IABP console while operating at 1:1 and 1:2 synchronization. In selected patients, recordings were obtained with the IABP timed to the high-fidelity aortic root waveform. In all 11 patients, inflation and deflation landmark delays were observed when comparing the aortic root waveforms to the IABP arterial pressure waveforms (inflation delay = 74 ± 29 [23-117] ms; deflation delay = 71 ± 37 [24-141] ms, mean ± standard deviation [min-max]). Delays were greater when compared to the radial artery waveform (inflation delay = 175 ± 50 [100-233] ms; deflation delay = 168 ± 52 [100-274] ms). In all cases, the landmark delays were statistically different from zero (P < 0.001). Diastolic augmentation and afterload reduction varied with waveform source. Conflicting indications of afterload reduction occurred in four patients. Timing to the aortic root waveform resulted in greater diastolic pressure augmentation and afterload reduction but mixed changes in stroke volume. Delay and distortion of the arterial waveform was consistently found when measured through the IABP catheter lumen. These delays can alter IABP efficacy and may be eliminated by using high-fidelity sensing of aortic pressure.

Comparison of Blood Viscoelasticity in Pediatric and Adult Cardiac Patients.

Evidence is accumulating that blood flow patterns in the cardiovascular system and in cardiovascular devices do, in some instances, depend on blood viscoelasticity. Thus, to better understand the challenges to providing circulatory support and surgical therapies for pediatric and adult patients, viscous and elastic components of complex blood viscoelasticity of 31 pediatric patients were compared to those of 29 adult patients with a Vilastic-3 rheometer. A random effects model with categorical age covariates found statistically significant differences between pediatric and adult patients for log viscosity (p = 0.005). Log strain (p < 0.0001) and hematocrit (p < 0.0001) effects were also significant, as were the hematocrit-by-log-strain (p = 0.0006) and age-by-log strain (p = 0.001) interactions. The hematocrit-by-age interaction was not significant. For log elasticity, age differences were insignificant (p = 0.39). The model for log elasticity had significant log strain (p < 0.0001), log strain squared (p < 0.0001) and hematocrit (p < 0.0001) effects, as well as hematocrit-by-log-strain and hematocrit-by-log-strain-squared interactions (p = 0.014). A model for log viscosity with continuous age was also fit to the data, which can be used to refine cardiovascular device design and operation to the age of the patient. We conclude that there are distinct differences between pediatric and adult blood viscosity, as well as substantial variation within the pediatric population, that may impact the performance of devices and procedures.

Predicted hemodynamic benefits of counterpulsation therapy using a superficial surgical approach.

A volume-displacement counterpulsation device (CPD) intended for chronic implantation via a superficial surgical approach is proposed. The CPD is a pneumatically driven sac that fills during native heart systole and empties during diastole through a single, valveless cannula anastomosed to the subclavian artery. Computer simulation was performed to predict and compare the physiological responses of the CPD to the intraaortic balloon pump (IABP) in a clinically relevant model of early stage heart failure. The effect of device stroke volume (0-50 ml) and control modes (timing, duration, morphology) on landmark hemodynamic parameters and the LV pressure-volume relationship were investigated. Simulation results predicted that the CPD would provide hemodynamic benefits comparable to an IABP as evidenced by up to 25% augmentation of peak diastolic aortic pressure, which increases diastolic coronary perfusion by up to 34%. The CPD may also provide up to 34% reduction in LV end-diastolic pressure and 12% reduction in peak systolic aortic pressure, lowering LV workload by up to 26% and increasing cardiac output by up to 10%. This study demonstrated that the superficial CPD technique may be used acutely to achieve similar improvements in hemodynamic function as the IABP in early stage heart failure patients.

Development and early testing of a simple subcutaneous counterpulsation device.

The intra-aortic balloon pump has been widely and successfully used as a treatment for cardiac dysfunction, but it only has short-term applications. To overcome this limitation, a superficial counterpulsation device (CPD) is being developed to provide extended counterpulsation support to promote myocardial recovery. The CPD is a valveless, monoport, pneumatically driven, 40-ml sac that is intended to be implanted in a pacemaker-type pocket in the subclavian fossa. The sac is designed to fill in systole and empty during diastole through an outflow graft anastomosed to the subclavian artery. A feasibility study was conducted to investigate acute hemodynamic responses to the CPD in eight calves with diminished cardiac function. The CPD augmented aortic diastolic pressure, reduced left ventricular peak systolic and aortic ejection pressures by up to 18%, and increased diastolic coronary flow by up to 21% and stroke volume by up to 12%. A cadaver fit study demonstrated that the human subclavian artery is a reasonable anastomosis site to consider and that the 40-ml CPD needs to be reduced in size to provide a better anatomical fit. The clinical attractiveness of this approach is that it may provide extended support through a subcutaneous surgical procedure.

The effect of gravitational acceleration on cardiac diastolic function: a biofluid mechanical perspective with initial results.

Echocardiographic measurements of astronaut cardiac function have documented an initial increase, followed by a progressive reduction in both left ventricular end-diastolic volume index and stroke volume with entry into microgravity (micro-G). The investigators hypothesize that the observed reduction in cardiac filling may, in part, be due to the absence of a gravitational acceleration dependent, intraventricular hydrostatic pressure difference in micro-G that exists in the ventricle in normal gravity (1-G) due to its size and anatomic orientation. This acceleration-dependent pressure difference, DeltaP(LV), between the base and the apex of the heart for the upright posture can be estimated to be 6660 dynes/cm(2) ( approximately 5 mm Hg) on Earth. DeltaP(LV) promotes cardiac diastolic filling on Earth, but is absent in micro-G. If the proposed hypothesis is correct, cardiac pumping performance would be diminished in micro-G. To test this hypothesis, ventricular function experiments were conducted in the 1-G environment using an artificial ventricle pumping on a mock circulation system with the longitudinal axis anatomically oriented for the upright posture at 45 degrees to the horizon. Additional measurements were made with the ventricle horizontally oriented to null DeltaP(LV)along the apex-base axis of the heart as would be the case for the supine posture, but resulting in a lesser hydrostatic pressure difference along the minor (anterior-posterior) axis. Comparative experiments were also conducted in the micro-G environment of orbital space flight on board the Space Shuttle. This paper reviews the use of an automated cardiovascular simulator flown on STS-85 and STS-95 as a Get Away Special payload to test this hypothesis. The simulator consisted of a pneumatically actuated, artificial ventricle connected to a closed-loop, fluid circuit with adjustable compliance and resistance elements to create physiologic pressure and flow conditions. Ventricular instrumentation included pressure transducers in the apex and base as well as immediately upstream of the inflow valve and downstream of the outflow valve, and a flow probe downstream of the outflow valve. By varying the circulating fluid volume, ventricular function could be determined for varying preload pressures at a regulated, mean afterload pressure of 95 mm Hg. This variation in preload condition permitted the construction of a ventricular function curve for the micro-G environment for comparison to the same curve for the 1-G environment. Data were collected from both missions at the upper end of the ventricular function curve. Experiment operation in the 1-G, supine orientation or in the micro-G environment eliminated the DeltaP(LV) observed in the 1-G, upright orientation. Consistent with the hypothesis, additional atrial pressure was required in micro-G to obtain stroke volumes and flow rates similar to those measured in 1-G for the upright posture. The necessary increase in atrial pressure was approximately 5 mm Hg in these experiments. In the same range of flow rates and stroke volumes, similar flows were observed in the 1-G supine posture for atrial pressures intermediate to the 1-G upright and micro-G values, also consistent with the hypothesis. Additional experiments on board the Space Shuttle are in preparation to gather data across the rest of the normal physiologic range of the ventricular function curve.

Does conventional intra-aortic balloon pump trigger timing produce optimal hemodynamic effects in vivo?

PURPOSE: The intra-aortic balloon pump (IABP) provides circulatory support through counterpulsation. The hemodynamic effects of the IABP may vary with assisting frequency and depend on IAB inflation/deflation timing. We aimed to assess in vivo the IABP benefits on coronary, aortic, and left ventricular hemodynamics at different assistance frequencies and trigger timings. METHODS: Six healthy, anesthetized, open-chest sheep received IABP support at 5 timing modes (EC, LC, CC, CE, CL, corresponding to early/late/conventional/conventional/conventional inflation and conventional/conventional/conventional/early/late deflation, respectively) with frequency 1:3 and 1:1. Aortic (Q(ao)) and coronary (Q(cor)) flow, and aortic (P(ao)) and left ventricular (PLV) pressure were recorded simultaneously, with and without IABP support. Integrating systolic Q(ao) yielded stroke volume (SV). RESULTS: EC at 1:1 produced the lowest end-diastolic P(ao) (59.5 ± 7.8 mmHg [EC], 63.4 ± 11.1 mmHg [CC]), CC at 1:1 the lowest systolic PLV (69.1 ± 6.5 mmHg [CC], 76.4 ± 6.5 mmHg [control]), CC at 1:1 the highest SV (88.5 ± 34.4 ml [CC], 76.6 ± 31.9 ml [control]) and CC at 1:3 the highest diastolic Qcor (187.2 ± 25.0 ml/min [CC], 149.9 ± 16.6 ml/min [control]). Diastolic P(ao) augmentation was enhanced by both assistance frequencies alike, and optimal timings were EC for 1:3 (10.4 ± 2.8 mmHg [EC], 6.7 ± 3.8 mmHg [CC]) and CC for 1:1 (10.8 ± 6.7 mmHg [CC], -3.0 ± 3.8 mmHg [control]). CONCLUSIONS: In our experiments, neither a single frequency nor a single inflation/deflation timing, including conventional IAB timing, has shown superiority by uniformly benefiting all studied hemodynamic parameters. A choice of optimal frequency and IAB timing might need to be made based on individual patient hemodynamic needs rather than as a generalized protocol.

Modeling and control of a brushless DC axial flow ventricular assist device.

This article presents an integrated model of the human circulatory system that incorporates circulatory support by a brushless DC axial flow ventricular assist device (VAD), and a feedback VAD controller designed to maintain physiologically sufficient perfusion. The developed integrated model combines a network type model of the circulatory system with a nonlinear dynamic model of the brushless DC pump We show that maintaining a reference differential pressure between the left ventricle and aorta leads to adequate perfusion for different pathologic cases, ranging from normal heart to left heart asystole, and widely varying physical activity scenarios from rest to exercise.

Physiologic control of rotary blood pumps: an in vitro study.

Rotary blood pumps (RBPs) are currently being used as a bridge to transplantation as well as for myocardial recovery and destination therapy for patients with heart failure. Physiologic control systems for RBPs that can automatically and autonomously adjust the pump flow to match the physiologic requirement of the patient are needed to reduce human intervention and error, while improving the quality of life. Physiologic control systems for RBPs should ensure adequate perfusion while avoiding inflow occlusion via left ventricular (LV) suction for varying clinical and physical activity conditions. For RBPs used as left ventricular assist devices (LVADs), we hypothesize that maintaining a constant average pressure difference between the pulmonary vein and the aorta (deltaPa) would give rise to a physiologically adequate perfusion while avoiding LV suction. Using a mock circulatory system, we tested the performance of the control strategy of maintaining a constant average deltaPa and compared it with the results obtained when a constant average pump pressure head (deltaP) and constant rpm are maintained. The comparison was made for normal, failing, and asystolic left heart during rest and at light exercise. The deltaPa was maintained at 95 +/- 1 mm Hg for all the scenarios. The results indicate that the deltaPa control strategy maintained or restored the total flow rate to that of the physiologically normal heart during rest (3.8 L/m) and light exercise (5.4 L/m) conditions. The deltaPa approach adapted to changing exercise and clinical conditions better than the constant rpm and constant deltaP control strategies. The deltaPa control strategy requires the implantation of two pressure sensors, which may not be clinically feasible. Sensorless RBP control using the deltaPa algorithm, which can eliminate the failure prone pressure sensors, is being currently investigated.

Effects of left ventricular assist device support and outflow graft location upon aortic blood flow.

Although continuous flow (CFVAD) and pulsatile (PVAD) ventricular assist devices (VADs) are being clinically used, their effects upon aortic blood flow as a measure of overall blood distribution remain unclear. The objective of this study was to compare the effects of CFVAD and PVAD support for ascending (AscA) and descending (DA) aorta outflow cannulation upon mean aortic blood flow and waveform morphology. Six experiments were conducted in a normal, acute calf model, in which an inflow cannula was implanted in the left ventricle apex and outflow cannulae were anastomosed to both the AscA and DA. Flow probes were placed around the pulmonary artery, pump outflow, brachiocephalic trunk, and aorta proximal and distal to the DA outflow. For each acute experiment, calves received randomly selected levels of VAD support (0-100% of cardiac output) and pump failure (VAD off and outflow cannula unclamped) for each of four randomly selected test conditions: (1) PVAD and AscA, (2) PVAD and DA, (3) CFVAD and AscA, and (4) CFVAD and DA. Regardless of pump type or support level, proximal and distal aorta mean flows were lower (p < 0.05) for DA compared with the AscA. No differences in mean aortic flows between pump types at either outflow graft location were discerned. Differences in morphologic features of blood flow waveforms between PVAD and CFVAD were observed. During simulated pump failure, retrograde aortic blood flow in both the aortic arch and DA was observed. Partial ventricular suction was also observed during the greatest levels of CFVAD support and suggested pronounced effects upon both the right and left ventricle. Collectively, these findings imply that VAD outflow location may have an important role in patient response and recovery. Investigation of the long-term pathophysiologic responses to pump type and outflow location is ongoing.

Characterization of an adult mock circulation for testing cardiac support devices.

A need exists for a mock circulation that behaves in a physiologic manner for testing cardiac devices in normal and pathologic states. To address this need, an integrated mock cardiovascular system consisting of an atrium, ventricle, and systemic and coronary vasculature was developed specifically for testing ventricular assist devices (VADs). This test configuration enables atrial or ventricular apex inflow and aortic outflow cannulation connections. The objective of this study was to assess the ability of the mock ventricle to mimic the Frank-Starling response of normal, heart failure, and cardiac recovery conditions. The pressure-volume relationship of the mock ventricle was evaluated by varying ventricular volume over a wide range via atrial (preload) and aortic (afterload) occlusions. The input impedance of the mock vasculature was calculated using aortic pressure and flow measurements and also was used to estimate resistance, compliance, and inertial mechanical properties of the circulatory system. Results demonstrated that the mock ventricle pressure-volume loops and the end diastolic and end systolic pressure-volume relationships are representative of the Starling characteristics of the natural heart for each of the test conditions. The mock vasculature can be configured to mimic the input impedance and mechanical properties of native vasculature in the normal state. Although mock circulation testing systems cannot replace in vivo models, this configuration should be well suited for developing experimental protocols, testing device feedback control algorithms, investigating flow profiles, and training surgical staff on the operational procedures of cardiovascular devices.

Left ventricular and myocardial perfusion responses to volume unloading and afterload reduction in a computer simulation.

Ventricular assist devices (VADs) have been used successfully as a bridge to transplant in heart failure patients by unloading ventricular volume and restoring the circulation. In a few cases, patients have been successfully weaned from these devices after myocardial recovery. To promote myocardial recovery and alleviate the demand for donor organs, we are developing an artificial vasculature device (AVD) that is designed to allow the heart to fill to its normal volume but eject against a lower afterload. Using this approach, the heart ejects its stroke volume (SV) into an AVD anastomosed to the aortic arch, which has been programmed to produce any desired afterload condition defined by an input impedance profile. During diastole, the AVD returns this SV to the aorta, providing counterpulsation. Dynamic computer models of each of the assist devices (AVD, continuous, and pulsatile flow pumps) were developed and coupled to a model of the cardiovascular system. Computer simulations of these assist techniques were conducted to predict physiologic responses. Hemodynamic parameters, ventricular pressure-volume loops, and vascular impedance characteristics were calculated with AVD, continuous VAD, and asynchronous pulsatile VAD support for a range of clinical cardiac conditions (normal, failing, and recovering left ventricle). These simulation results indicate that the AVD may provide better coronary perfusion, as well as lower vascular resistance and elastance seen by the native heart during ejection compared with continuous and pulsatile VAD. Our working hypothesis is that by controlling afterload using the AVD approach, ventricular cannulation can be eliminated, myocardial perfusion improved, myocardial compliance and resistance restored, and effective weaning protocols developed that promote myocardial recovery.

Hemodynamic and pressure-volume responses to continuous and pulsatile ventricular assist in an adult mock circulation.

This study investigated the hemodynamic and left ventricular (LV) pressure-volume loop responses to continuous versus pulsatile assist techniques at 50% and 100% bypass flow rates during simulated ventricular pathophysiologic states (normal, failing, recovery) with Starling response behavior in an adult mock circulation. The rationale for this approach was the desire to conduct a preliminary investigation in a well controlled environment that cannot be as easily produced in an animal model or clinical setting. Continuous and pulsatile flow ventricular assist devices (VADs) were connected to ventricular apical and aortic root return cannulae. The mock circulation was instrumented with a pressure-volume conductance catheter for simultaneous measurement of aortic root pressure and LV pressure and volume; a left atrial pressure catheter; a distal aortic pressure catheter; and aortic root, aortic distal, VAD output, and coronary flow probes. Filling pressures (mean left atrial and LV end diastolic) were reduced with each assist technique; continuous assist reduced filling pressures by 50% more than pulsatile. This reduction, however, was at the expense of a higher mean distal aortic pressure and lower diastolic to systolic coronary artery flow ratio. At full bypass flow (100%) for both assist devices, there was a pronounced effect on hemodynamic parameters, whereas the lesser bypass flow (50%) had only a slight influence. Hemodynamic responses to continuous and pulsatile assist during simulated heart failure differed from normal and recovery states. These findings suggest the potential for differences in endocardial perfusion between assist techniques that may warrant further investigation in an in vivo model, the need for controlling the amount of bypass flow, and the importance in considering the choice of in vivo model.

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.

End-diastolic flow reversal limits the efficacy of pediatric intra-aortic balloon pump counterpulsation.

BACKGROUND: Counterpulsation with an intra-aortic balloon pump (IABP) has not achieved the same success or clinical use in pediatric patients as in adults. In a pediatric animal model, IABP efficacy was investigated to determine whether IABP timing with a high-fidelity blood pressure signal may improve counterpulsation therapy versus a low-fidelity signal. METHODS: In Yorkshire piglets (n = 19; weight, 13.0 ± 0.5 kg) with coronary ligation-induced acute ischemic left ventricular failure, pediatric IABPs (5 or 7 mL) were placed in the descending thoracic aorta. Inflation and deflation were timed with traditional criteria from low-fidelity (fluid-filled) and high-fidelity (micromanometer) blood pressure signals during 1:1 support. Aortic, carotid, and coronary hemodynamics were measured with pressure and flow transducers. Myocardial oxygen consumption was calculated from coronary sinus and arterial blood samples. Left ventricular myocardial blood flow and end-organ blood flow were measured with microspheres. RESULTS: Despite significant suprasystolic diastolic augmentation and afterload reduction at heart rates of 105 ± 3 beats per minute, left ventricular myocardial blood flow, myocardial oxygen consumption, the myocardial oxygen supply/demand relationship, cardiac output, and end-organ blood flow did not change. Statistically significant end-diastolic coronary, carotid, and aortic flow reversal occurred with IABP deflation. Inflation and deflation timed with a high-fidelity versus low-fidelity signal did not attenuate systemic flow reversal or improve the myocardial oxygen supply/demand relationship. CONCLUSIONS: Systemic end-diastolic flow reversal limited counterpulsation efficacy in a pediatric model of acute left ventricular failure. Adjustment of IABP inflation and deflation timing with traditional criteria and a high-fidelity blood pressure waveform did not improve IABP efficacy or attenuate flow reversal. End-diastolic flow reversal may limit the efficacy of IABP counterpulsation therapy in pediatric patients with traditional timing criteria. Investigation of alternative deflation timing strategies is warranted.