Surgical principle in total artificial heart--an experimental review

Based on implantation experiments in calves resulted some experiences for the implantation technic of artificial hearts. After resection of the natural ventricles and of the valvular parts of the aorta and pulmonary artery the connectors should be adapted and implanted. The first connected left ventricle get a caudal-lateral traction especially under supervision of the pulmonary veins and optimal development of the aorta. During connection of the right ventricle it is necessary to check up the inflow - and outflow tract situation. May be, the left ventricle get with this maneuver an unfavourable caudal kinking. Careful preparation and splitting of the pericardium is necessary to avoid obstructions for the venous flow. The closing of the chest and initial changes in position of the animal may alternate good positions of the heart, if the resection as well as preparation, adaptation and bedding don't remarked the discussed principles. One of the most relevant aspects in achieving the consistent survival of an animal undergoing the experimental implantation of a total artificial heart is obviously related to the correct anatomic placement of prosthetic ventricles inside the chest. In this case, the skillful surgical procedures based on an established surgical principle are considered to be attributable in obtaining the optimal hemodynamic situation. Description of the surgical procedures has been made elsewhere. However, it has been difficult to find a well defined surgical principle although particular milestone has already been made by a clinical application of the total artificial heart in 1982. Although the presently available prosthetic ventricles generally fit better in the chest, the problems in design and size of the prosthesis still exist.(ABSTRACT TRUNCATED AT 250 WORDS)