Preclinical Proof-of-Concept of a Minimally Invasive Direct Cardiac Compression Device for Pediatric Heart Support.

Purpose: For pediatric patients, extracorporeal membrane oxygenation (ECMO) remains the predominant mechanical circulatory support (MCS) modality for heart failure (HF) although survival to discharge rates remain between 50 and 60% for these patients. The device-blood interface and disruption of physiologic hemodynamics are significant contributors to poor outcomes.

Methods: In this study, we evaluate the preclinical feasibility of a minimally invasive, non-blood-contacting pediatric DCC prototype for temporary MCS.

A New Strain Energy Function Representing the Passive Behavior of the Myocardium.

Classical models for the passive myocardium, such as the Fung and Holzapfel-Ogden models, are known to have high degeneracy as well as numerous mechanical and mathematical limitations, preventing their utility in microstructural experiments and precision medicine. Hence, the upper triangular (QR) decomposition and orthogonal strain attributes were leveraged to develop a new model using published biaxial data on slabs of left myocardium, resulting in a separable strain energy function. This new model, the Criscione-Hussein model, was compared with both the Fung and Holzapfel-Ogden models by quantifying the uncertainty, computational efficiency, and material parameter fidelity for all three models.

Mechanical Cardiac Support With an Implantable Direct Cardiac Compression Device: Proof of Concept.

Purpose: We examined the hemodynamic effects of a new, implantable, direct cardiac assist device in an ovine heart failure model.

Description: The device, which encompasses both left and right ventricles, is inserted through the pericardial apex and self-expands to encompass the heart without suturing. The intact pericardium anchors the device in place.

The CorInnova Implantable Cardiac Assist System for Direct Cardiac Compression.

The CorInnova cardiac compression device (CorInnova, Inc., Houston, TX, USA) is designed to provide direct biventricular support, increase cardiac output, and improve ventricular unloading in patients with heart failure. Placed within the pericardium and surrounding both ventricles, the device has two concentric sets of thin-film polyurethane chambers: (1) inner (epicardial) saline-filled chambers that conform intimately to the epicardial surface, eradicating any gaps in the interface between the device and the heart; and (2) outer air-filled chambers cycled to provide epicardial compression during systole and negative epicardial pressure during diastole, consistent with physiological cardiac contraction and relaxation.

Electrical weapons and rhabdomyolysis.

It has been suggested that an application of a conducted electrical weapon (CEW) might cause muscle injury such as rhabdomyolysis and an acute inflammatory response. We explored this hypothesis by testing the effects of electrical weapons on circulating markers of inflammation and muscle damage. In a prospective study, 29 volunteers received a full-trunk 5-s TASER® X26(E) CEW exposure.

Electrical weapons, hematocytes, and ischemic cardiovascular accidents.

Background: There have been case reports following the use of a conducted electrical weapon (CEW) suggesting that these devices might affect coagulation or thrombosis in at-risk individuals. The aim of this manuscript therefore is firstly to explore this hypothesis by reviewing each of these cases and secondly to report the results of a prospective study exploring a priori the effects of electrical weapons on hematocytes in a group of human volunteers.

Methods: First, we systematically reviewed all cases of adverse outcomes following CEW discharge that could be due to an effect on coagulation or thrombosis, with particular focus on the clinical scenario and its relationship with the weapon discharge.

Evaluation of the CorInnova Heart Assist Device in an Acute Heart Failure Model.

While the number of patients supported with temporary cardiac assist is growing, the existing devices are limited by a multitude of complications, mostly related to contact with the blood. The CorInnova epicardial compressive heart assist device was tested in six sheep using an acute heart failure model. High esmolol dose, targeting a 50% reduction in CO from healthy baseline, resulted in a failure state with mean CO 1.

Electrical weapons and excited delirium: shocks, stress, and serum serotonin.

It has been suggested that a CEW (conducted electrical weapon) exposure could elicit a stress response that could cause ExDS (excited delirium syndrome). There are some parallels between the signs of ExDS and serotonin syndrome (SS). Electroconvulsive therapy raises serotonin levels and therefore provides a plausible link between CEW applications and elevated serotonin levels.

An experimental canine patent ductus arteriosus occlusion device based on shape memory polymer foam in a nitinol cage.

Patent ductus arteriosus (PDA) is a congenital cardiovascular defect in which a fetal connection between the aorta and pulmonary artery does not spontaneously close shortly after birth. If left uncorrected serious complications and even death can occur. Surgical ligation is the traditional treatment method; however, it is an invasive procedure, that motivates development of a minimally invasive option.

Functional adaptation of bovine mesenteric lymphatic vessels to mesenteric venous hypertension.

Lymph flow is the primary mechanism for returning interstitial fluid to the blood circulation. Currently, the adaptive response of lymphatic vessels to mesenteric venous hypertension is not known. This study sought to determine the functional responses of postnodal mesenteric lymphatic vessels.

Incapacitation recovery times from a conductive electrical weapon exposure.

Purpose: Law enforcement officers expect that a TASER(®) CEW (Conducted Electrical Weapon) broad-spread probe exposure will temporarily incapacitate a subject who will then be able to immediately (~1 s delay) recover motor control in order to comply with commands. However, this recovery time has not been previously reported.

Methods: A total of 32 police academy students were exposed to a very broad-spread 5 s CEW stimulus as part of their training and told to depress a push-button as soon as they sensed the stimulus.

Efficient characterization of inhomogeneity in contraction strain pattern.

Cardiac dyssynchrony often accompanies patients with heart failure (HF) and can lead to an increase in mortality rate. Cardiac resynchronization therapy (CRT) has been shown to provide substantial benefits to the HF population with ventricular dyssynchrony; however, there still exists a group of patients who do not respond to this treatment. In order to better understand patient response to CRT, it is necessary to quantitatively characterize both electrical and mechanical dyssynchrony.

Estimation of aneurysm wall stresses created by treatment with a shape memory polymer foam device.

In this study, compliant latex thin-walled aneurysm models are fabricated to investigate the effects of expansion of shape memory polymer foam. A simplified cylindrical model is selected for the in-vitro aneurysm, which is a simplification of a real, saccular aneurysm. The studies are performed by crimping shape memory polymer foams, originally 6 and 8 mm in diameter, and monitoring the resulting deformation when deployed into 4-mm-diameter thin-walled latex tubes.

Characterization of mechanical behavior of a porcine pulmonary artery strip using a randomized uniaxial stretch and stretch-rate protocol.

Background: Much of the experimental work in soft tissue mechanics has been focused on fitting approximate relations for specific tissue types from aggregate data on multiple samples of the tissue. Such relations are needed for modeling applications and have reasonable predictability - especially given the natural variance in specimens. There is, however, much theoretical and experimental work to be done in determining constitutive behaviors for particular specimens and tissues.

Kinematics framework optimized for deformation, growth, and remodeling in vascular organs.

A basic tenant of constitutive theory is that phenomenological relations can be derivable from phenomenological behavior or material tests; and yet, conventional representation formulas, such as those of Rivlin and Fung, fail in this regard because of the choice of kinematical variables. Granted, with these representation formulas a particular constitutive relation may be guessed that fits data, but if the relation is non-unique and cannot be derived de novo from actual and/or hypothetical tests, then such a relation is indeterminable. The representation formula of Rivlin is indeterminable because of excessive covariance or coalignment in the kinematical variables.

Alterations in lateral left ventricular wall transmural strains during acute circumflex and anterior descending coronary occlusion.

Background: Increased circumferential-radial shear in the midlateral left ventricle adjacent to ischemic myocardium has been observed during acute midcircumflex ischemia in open-chest animals. Extending this work, we studied transmural strains in closed-chest animals during acute proximal-circumflex (pCX) and proximal-left anterior descending (pLAD) occlusions.

Methods: Six sheep had radiopaque markers implanted to silhouette the left ventricle and measure regional systolic fractional area shortening; three transmural bead columns were inserted into the midlateral wall for transmural myocardial strain analysis.

Stented artery biomechanics and device design optimization.

The deployment of a vascular stent aims to increase lumen diameter for the restoration of blood flow, but the accompanied alterations in the mechanical environment possibly affect the long-term patency of these devices. The primary aim of this investigation was to develop an algorithm to optimize stent design, allowing for consideration of competing solid mechanical concerns (wall stress, lumen gain, and cyclic deflection). Finite element modeling (FEM) was used to estimate artery wall stress and systolic/diastolic geometries, from which single parameter outputs were derived expressing stress, lumen gain, and cyclic artery wall deflection.

Transmural sheet strains in the lateral wall of the ovine left ventricle.

In an attempt to provide a better understanding of our finding that regions with contracting left ventricular myofibers need not develop a significant transmural systolic wall thickening gradient, the analytic approach of Costa et al. was applied to the four-dimensional dynamic data obtained 1 and 8 wk after surgical implantation of transmural radiopaque beads in the lateral equatorial left ventricular wall in seven ovine hearts. Quantitative histology of tissue blocks demonstrated that fiber angles varied linearly across the wall in this region from -37 degrees in the subepicardium to +18 degrees in the subendocardium.

Alterations in transmural strains adjacent to ischemic myocardium during acute midcircumflex occlusion.

Objective: Helically oriented left ventricular fibers assemble into transmural sheets, which are important for wall-thickening mechanics: 15% fiber shortening results in 40% cross-fiber left ventricular wall thickening and a 60% ejection fraction through sheet extension, thickening, and shear. Normal cardiac microstructure and strains are optimized; deviations could result in apoptosis and deleterious matrix remodeling, which degenerates into global cardiomyopathy. We studied alterations in transmural strains adjacent to ischemic myocardium during acute midcircumflex occlusion.

Transmural cardiac strains in the lateral wall of the ovine left ventricle.

The constant-volume property of contracting cardiac muscle has been invoked in models of heart wall mechanics that predict that systolic subendocardial left ventricular (LV) wall thickening must significantly exceed subepicardial thickening. To examine this prediction, we implanted arrays of radiopaque markers to measure lateral equatorial wall transmural strains and global and regional LV geometry in seven sheep and studied the four-dimensional dynamics of these arrays using biplane videofluoroscopy (60 Hz) in anesthetized intact animals 1 and 8 wk after surgery. A transmural gradient of systolic lateral wall thickening was observed at 1 wk (P = 0.

Direct measurement of transmural laminar architecture in the anterolateral wall of the ovine left ventricle: new implications for wall thickening mechanics.

Laminar, or sheet, architecture of the left ventricle (LV) is a structural basis for normal systolic and diastolic LV dynamics, but transmural sheet orientations remain incompletely characterized. We directly measured the transmural distribution of sheet angles in the ovine anterolateral LV wall. Ten Dorsett-hybrid sheep hearts were perfusion fixed in situ with 5% buffered glutaraldehyde at end diastole and stored in 10% formalin.

Importance of mitral valve second-order chordae for left ventricular geometry, wall thickening mechanics, and global systolic function.

Background: Mitral valvular-ventricular continuity is important for left ventricular (LV) systolic function, but the specific contributions of the anterior leaflet second-order "strut" chordae are unknown.

Methods And Results: Eight sheep had radiopaque markers implanted to silhouette the LV, annulus, and papillary muscles (PMs); 3 transmural bead columns were inserted into the mid-lateral wall between the PMs. The strut chordae were encircled with exteriorized wire snares.

Transmural left ventricular mechanics underlying torsional recoil during relaxation.

Early relaxation in the cardiac cycle is characterized by rapid torsional recoil of the left ventricular (LV) wall. To elucidate the contribution of the transmural arrangement of the myofiber to relaxation, we determined the time course of three-dimensional fiber-sheet strains in the anterior wall of five adult mongrel dogs in vivo during early relaxation with biplane cineangiography (125 Hz) of implanted transmural markers. Fiber-sheet strains were found from transmural fiber and sheet orientations directly measured in the heart tissue.

Experimentally tractable, pseudo-elastic constitutive law for biomembranes: II. Application.

This is the second paper of a 2 part series. In the first, a theoretical framework is developed that provides 3 enhancements for the constitutive theory of biomembranes. 1) Covariance amongst response terms is minimized, 2) the pseudo-strain-energy potential is redefined so as to be measurable, and 3) the stress response is decomposed into 2 parts--a hyperelastic part plus a hypoelastic-stress-residual.