IMPLANTATION SURGERY OF 
ARTIFICIAL HEARTS 
T. Akutsu, H. Takagi and H. Takano* 
This paper describes surgical techniques for implan- 
tation of various artificial hearts in calves. Artificial 
hearts developed in our laboratory involve bypass-type 
heart assist device (B-HAD), series-type heart assist 
device (S-HAD), and total artificial heart (TAH). 
Animals were not fed for one or two days prior to 
surgery. Anesthesia was induced with short-acting bar- 
bituate and maintained with Fluothane. For implanta- 
tion of all three types of artificial hearts the chest was 
opened through the fifth intercostal space. During sur- 
gery the animal was connected to a Bird respirator. The 
B-HAD was connected first to the descending aorta by 
end-to-side anastomosis of the outlet connector, and 
then to the left atrium. For implantation of the S-HAD 
and TAH, extracorporeal circulation was used. Because 
of particular anatomy of the ascending aorta and the 
aortic arch in calves, two arterial cannulas were re- 
quired to perfuse the upper and lower parts of the 
body. Venous blood was also drained with two cannu- 
las. One was inserted into the inferior vena cava 
through the right atrial appendage, and the other into 
the superior vena cava from the right jugular vein. Dur- 
ing implantation of the S-HAD, the coronary arteries 
were perfused. The inlet cuff of the S-HAD was con- 
nected to the ascending aorta by end-to-end anastomo- 
sis, and the distal cut end of the ascending aorta was 
closed. The TAH was connected to the natural counter- 
parts in the order of right atrium, left atrium, aorta, 
and pulmonary artery. Pumping with each device was 
initiated " after the residual air was completely re- 
moved. The chest was closed in routine fashion. Post- 
operatively, antibiotics were administered routinely for 
about a week. 
INTRODUCTION 
Differences in surgical procedures in large 
animals from those in patients are mainly due 
to differences in anatomy. There are no big dif- 
ferences in responses to anesthetics and other 
drugs which are used during surgery and imme- 
diate postoperative course. This paper describes 
preoperative care, implantation techniques for 
various types of artificial hearts, and postopera- 
tive care in dogs, sheep, and calves. The devices 
* Department of Surgery University of Mississippi Medical Center 
Jackson, Mississippi 
implanted were bypass-type left heart assist de- 
vice (B-LHAD) , series type left heart assist de- 
vice (S-LHAD), and total artificial heart 
(TAH). Dogs weighing about 20 kg were used 
only in the early stage in the series-type heart 
assist device experiments. The sheep and calves 
used weighed from 70 to 90 kg. 
PREOPERATIVE CARE 
Experimental animals were not fed for at 
least one day before surgery. Ruminants, par- 
ticularly sheep, were not fed for two days being 
allowed to take only water. When ruminants 
were not being fed grass or hay but were being 
fed pellet or mixed feed, they were used without 
preoperative fast since stomach irrigation was 
performed without much difficulty. Usually 
preoperative administration of antibiotics was 
not applied. 
ANESTHESIA 
All dogs were anesthetized by slow intrave- 
nous administration of Nembutal (pentobarbi- 
tal, 25 mg/kg) . Additional doses, ranging from 
5 to 10 mg, were given if necessary. 
In sheep and calves, 0.4 mg of atropine sul- 
fate was given intravenously about 30 minutes 
prior to induction of anesthesia to inhibit sali- 
vation. Since it was reported^ that these ani- 
mals were sensitive to long-acting barbiturates 
and that their agents produced prolonged res- 
piratory depression, short-acting Surital (so- 
dium thiamylal) was used for induction of 
anesthesia in doses barely sufficient to allow en- 
dotracheal intubation (30 ml of 2.5% solution). 
Intubation was performed after the animals 
were fixed on the operative table in supine posi- 
tion. For intubation of sheep and calves, tools 
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