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(Circulation. 2001;104:717.)
© 2001 American Heart Association, Inc.

Basic Science Reports

Biomechanical Hearts

Muscular Blood Pumps, Performed in a 1-Step Operation, and Trained Under Support of Clenbuterol

Norbert W. Guldner, MD; Peter Klapproth, DMSc; Martin Großherr, MD; Andreas Brügge, MD; Abdolhamid Sheikhzadeh, MD; Ralph Tölg, MD; Elisabeth Rumpel, MD; Ralf Noel, DVM; Hans-H. Sievers, MD, FETCS

From the Clinic of Cardiac Surgery (N.W.G., P.K., A.B., H.-H.S.), Institutes of Anesthesiology (M.G.), Clinic of Cardiology (A.S., R.T.), Anatomy (E.R.), and Animal Care (R.N.), Medical University of Lübeck, Lübeck, Germany.

Correspondence to Priv Doz Dr med Norbert W. Guldner, Klinik für Herzchirurgie, Medizinische Universität zu Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany. E-mail guldner{at}medinf.mu-luebeck.de

Background—— As shown previously in goats, clenbuterol increased the power of electrically conditioned skeletal muscle ventricles (SMVs) of clinically relevant size (150 mL), which were constructed around a mock system. They pumped against a pressure of 60 to 70 mm Hg immediately during surgery and up to several months after, finally at >1 L/min. SMVs without clenbuterol administration failed. Thus, we expected that clenbuterol-supported SMVs might become integrated into the circulation by a 1-step operation instead of the 2-step procedure required up to now.

Methods and Results—— In adult Boer goats (n=5), latissimus dorsi muscle was wrapped around a polyurethane chamber of 150 mL that was connected to the descending aorta. This muscular flow-through pumping chamber containing a stabilizing inner layer (called a biomechanical heart [BMH]) was formed and immediately made to work against a systemic load with the support of clenbuterol (5x150 µg/wk). During surgery, the mean stroke volume of BMHs was 53.8±22.4 mL. One month after surgery, in peripheral arterial pressure, the mean diastolic (P_MD) and minimal diastolic (P_min) pressures of BMH-supported heart cycles differed significantly from unsupported ones (P_MD=+2.9±1.1 mm Hg [P<0.04], P_min=-2.4±0.9 mm Hg [P<0.04]). After BMH-supported heart contractions, the subsequent maximal rate of pressure generation, dP/dt_max, increased by 20.5±8.1% (P<0.02). One BMH, catheterized 132 days after surgery, shifted a volume of 34.8 mL per beat and 1.4 L/min with a latissimus dorsi muscle of 330 g. Depending on duration of training, the percentage of myosin heavy chain type 1 ranged between 31% and 100%.

Conclusions—— Under support of clenbuterol, BMHs of a clinically relevant size can be trained effectively in the systemic circulation after a 1-step operation and offer the prospect of a sufficient volume shift and probably unloading of the left ventricle.

Key Words: muscles • electrical stimulation • circulation • clenbuterol • heart-assist device

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