Skeletal muscle ventricles for total heart replacement

Area of Science:

• Biomedical Engineering
• Cardiovascular Surgery
• Regenerative Medicine

Background:

• Congestive heart failure remains a leading cause of mortality worldwide.
• Current treatments for end-stage heart failure, such as cardiac transplantation, face limitations due to donor scarcity and immune rejection.
• Skeletal muscle ventricles (SMVs) offer a potential autologous solution for cardiac replacement.

Purpose of the Study:

• To evaluate the functional capacity of skeletal muscle ventricles (SMVs) constructed from canine latissimus dorsi muscle.
• To assess the impact of different resting periods and electrical conditioning on SMV performance.
• To determine the potential of SMVs to replace native cardiac function.

Main Methods:

• Construction of SMVs from canine latissimus dorsi muscle.
• Grouping of SMVs into three protocols: short rest (4 weeks), short rest with electrical conditioning (4 weeks rest + 6 weeks conditioning), and long rest (18 weeks).
• Acute testing of SMV performance using a mock-circulation device at physiologic preloads and afterloads.

Main Results:

• SMVs rested for 18 weeks (Group C) achieved superior stroke work, reaching 194% of left ventricular stroke work at 80 mmHg afterload.
• SMVs with 6 weeks of electrical conditioning (Group B) produced work outputs equivalent to 53% of the left ventricle.
• SMV performance in Group C surpassed previously reported work outputs for similar devices.

Conclusions:

• Skeletal muscle ventricles can generate sufficient work to potentially replace cardiac function under physiologic conditions.
• Long-term resting of SMVs demonstrates significant functional capacity.
• Electrical conditioning also enhances SMV performance, offering a viable option for cardiac assist or replacement.