Statement Regarding the Pre and Post Market Assessment of Durable, Implantable Ventricular Assist Devices in the United States: Executive Summary

Transplant in the 21st century

Organ transplantation has enriched and prolonged the lives of many patients who otherwise would have died of organ failure. Many of these advances, which occurred in the later part of the 20th century, are due to improved techniques and pharmacological management. Today, almost every organ can be transplanted. However, donor and recipient criteria can vary widely according to the organ(s) in question. This article reviews the historical changes that have occurred in transplant along with current criteria for donors and recipients, and describes the newest outreach to increase the donor pool.

Skeletal muscle bioenergetics during frequency-dependent fatigue

The bioenergetic correlates of skeletal muscle fatigue were assessed in vivo with phosphorus-31 nuclear magnetic resonance (31P-NMR) spectroscopy. After surgical construction of latissimus dorsi muscle ventricles, seven beagles underwent 31P-NMR spectroscopy during 12-min exercise protocols at 25- and 85-Hz stimulation frequencies and during both isovolumetric and dynamic contractions. Exercise at 85 Hz was associated with significantly greater fatigue than exercise at 25 Hz. At both frequencies, the onset of exercise was associated with a marked increase in inorganic phosphate (Pi) and a decrease in phosphocreatine (PCr). As the muscle fatigued at 85 Hz but not at 25 Hz, the phosphorus spectra returned to near baseline with a decrease in Pi and increase in PCr. For a given amount of force generated, the Pi-to-PCr ratio was higher for dynamic contractions than for isovolumetric contractions. This study indicates that high-frequency fatigue is unlikely to result from the direct effects of high-energy phosphate metabolism and that contractions producing external work consume more metabolic energy than equally forceful isometric contractions.

Functional electrical stimulation of the latissimus dorsi muscle for use in cardiac assist

Direct and nondirect nerve stimulation modes of the thoraco-dorsal nerve (TDN) leading to the latissimus dorsi muscle (LDM) were evaluated by using nerve cuff electrodes (NCE) and intramuscular electrodes (IME), respectively. Following electrode implantation, the LDM was chronically stimulated for two months to induce muscle transformation to oxidative, fatigue-resistant type I muscle fibers. Threshold and impedance values were measured regularly to establish the stability of the implants. The LDM was then dissected, shaped into a ventricle, subjected to a hydraulic load and stimulated using a controlled-voltage pulse-train stimulator with adjustable parameters. Electrical input and hydraulic output variables were measured to obtain the recruitment characteristics and to compare the efficiency of the two types of electrodes. Results indicate a tradeoff between the NCE's lower threshold, higher recruitment, and lower energy consumption at saturation, and the IME's greater mechanical stability and better long-term reproducibility.