The Canadian journal of cardiology
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Historical and state-of-the-art review of clinical mechanical circulatory assist and replacement devices. Recent clinical experience at the University of Ottawa Heart Institute with various mechanical circulatory assist devices as a bridge to transplant, and experimental results with the development and testing of a new electrohydraulic ventricular assist device, are described in detail. ⋯ The use of these devices has become an accepted treatment for end-stage heart disease. Additional development and testing is required to address persistent complications in most models if they are to become alternatives to cardiac transplantation. The basis of the future successes is dependent on both technological refinements in the developments of new devices and on continued research into the physiological effects of mechanical circulatory support. However, these devices are used both as a bridge to recovery and a bridge to cardiac transplant and it is expected that they will be used increasingly to provide permanent circulatory assistance or replacement.
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In vitro experiments have shown that an electric field changes coronary vascular resistance (CVR) tone and damages the vascular endothelium. The effect of transthoracic electric current in dogs on the vasodilatory responses mediated through the endothelium and reactive hyperemia were studied. The manner of delivery of the electric current was similar to that used clinically during cardiac resuscitation. ⋯ These results show that transthoracic electrical shocks as used clinically induce coronary vasodilation but simultaneously produce endothelial dysfunction.