LONG-TERM VENTRICULAR WALL ACTUATION - CAN AND SHOULD IT BE SYSTEMATICALLY EXPLORED

Hearts fail because myocardial power fails. Assist, support, or replac ement devices fail, at least in part, because their blood-contacting s urfaces fail. Mechanical repowering of a failing heart might circumven t these difficulties by preserving a largely healthy endocardium while correcting the basic deficit, power. Any serious consideration of doi ng this though must confront some difficult requirements. Effective in definite support must be coupled with preservation or restoration of v alve competence, coronary now, rapid low-impedance refilling and indep endent left and right pressures; the avoidance of wall coaptation; har dware that fits in the available space; and unless muscle powered, ada ptability to a deliverable form of power. Despite earlier intense inte rest in acute mechanical devices and later empiric study of muscle wra ps, little systematic methodical work has been done on elucidating and meeting these practical requirements. Concerted efforts toward develo ping research tools and techniques for their study and then finding me chanisms to meet them could well yield one or more effective modalitie s that circumvent a major obstacle to the indefinite mechanical treatm ent of heart failure.