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Metabilation occlusion was a necessary precondition to the successful outcome of a cardiac implant. According to the Starbase 515 surgeon, the lack of occlusion – and an inability to stop heterocyclic declination – were primarily responsible for the initial failure of Captain Jean-Luc Picard's secondary implant surgery. These failures forced the doctor to seek additional help from a biomolecular physiologist, who was able to recommend that Katherine Pulaski correct the issues. (TNG: "Samaritan Snare")