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DISCUSSION 
CHAIRMAN Michael P. Kaye: This very fine 
presentation is now open for discussion. What 
type of pulmonary pathology did you find in the 
sheep lungs at autopsy? 
Dr. Akutsu: Severe atelectasis and hemor- 
rhage. We divided the sheep into two groups. In 
the first group we didn't use any particular 
medication, and we found severe pathological 
ordination. After that we started using diben- 
zyline and thorazine, and we noticed some im- 
provement. But we had much less of a problem 
in this area when we used calves. 
Craig Hassler, Battelle Columbus Labora- 
tory: What were the interior surfaces of 
these hearts and what did they look like after 
the eight to ten days survival ? 
Dr. Akutsu : As you know, it is very difficult 
to keep the surface of silk and rubber clean, and 
until the device is ready to use for implantation, 
it has to go through many procedures with 
prospects for contamination. We coat the entire 
internal surface just before implantation, so 
that it's just a smooth surface of silk and rub- 
ber. None of the calves died by thrombolysis. 
After 10 days survival, one of the animals had 
developed a thrombus formation at the bottom 
of the aortic valve leaflet. The others stayed 
very clean, but we found some infarcts in the 
kidneys. 
Victor W. Bolie, University of New 
Mexico: Would you comment on the types of 
valves you used and also on the status of the 
biolyzed material, the aldehyde-treated connec- 
tive tissue lining for devices? 
Dr. Akutsu : Our device uses the oval shape 
valve opening to save space. In our elliptical 
valve is a major axis of about 2 inches with one 
membrane hanging in the ventricle. During 
contractions, the blood pushes the large mem- 
brane against one side of the ventricular wall 
and the other side of the ventricular wall is 
pushed against the membrane. It works like a 
leaflet or bicuspid valve. We call this a bicuspid 
S-shaped valve, leaflet type, because the closure 
line looks like an "S." I don't know about the 
surface of the material. I have experience only 
with a smooth silk and rubber surface. 
Gerald Moss, Troy, New York : Why do you 
have six chambers in your peristaltic pump? It 
seems to me you theoretically lose any benefit 
beyond three. 
Dr. Akutsu: Each chamber is approxi- 
mately 25 cc. After the complete bypass, when 
the animal or patient doesn't need any more 
help from the device, we have to wean him from 
it. But I don't think it is good to put the whole 
responsibility back to the natural heart sud- 
denly. So to be able to regulate the weaning 
from the device, we have six chambers so that 
we can reduce the use of the device one chamber 
at a time. We also can regulate the weaning 
from the device by triggering from one to two 
chambers all the way up to one to five cham- 
bers. 
Dr. Moss: My point is that if you think in 
terms of peristalsis, your stroke volume is one 
chamber and you don't need those distal to it to 
continue moving the blood along. So your rate 
can change but your stroke volume is that of 
one chamber collapsing, and the other three 
chambers are just redundant. 
Dr. Akutsu : I don't know how you can con- 
trol the cardiac output in one chamber. We con- 
sider this peristalsis assist device as a tempo- 
rary aid, so that we don't have to stick to the 
