Alternate antegrade/retrograde perfusion: an effective technique to preserve hypertrophied hearts during valvular surgery

Jian Wang, Hongyu Liu, Tomas Salerno, Boguslaw Tomanek, Randy Summers, Roxanne Deslauriers, Rakesh C. Arora, Ganghong Tian

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objective: Continuous antegrade perfusion (AP) may interfere with surgical precision. Continuous retrograde perfusion (RP), on the other hand, cannot sustain the empty-beating hypertrophied hearts. Therefore, alternate antegrade/retrograde perfusion (AA/RP) may be a rational technique to preserve the hypertrophied hearts. This study is to determine whether AA/RP could maintain myocardial energy metabolism, oxygenation, and contractile function of the empty-beating hypertrophied hearts. Methods: Sixteen hypertrophied pig hearts were divided into four groups (n = 4 per group). Group I and II underwent an 80-min AA/RP (four 10-min APs and four 10-min RPs), followed by a 20-min reperfusion. Group III and IV were subjected to an 80-min AP and 20-min reperfusion and used as a control. Energy metabolism was evaluated in group I and III using magnetic resonance spectroscopy. Myocardial oxygenation (MO) was assessed in group II and IV using near infrared spectroscopic imaging. Results: During 80-min AA/RP, four episodes of RP resulted in a significant decrease in myocardial phosphocreatine (PCr) and MO. The subsequent AP, however, resulted in complete recovery of the parameters. Moreover, myocardial adenosine triphosphate (ATP) remained at a normal level throughout the 80-min AA/RP. As expected, hearts in groups III and IV showed normal level of myocardial PCr, ATP, and MO throughout protocol. Finally, hearts in all four groups showed similar contractile function during reperfusion. Conclusions: AA/RP with four 10-min intervals of AP and RP sustained normal myocardial energy metabolism, oxygenation, and contractile function of empty-beating hypertrophied hearts. We conclude that AA/RP is an effective technique for preservation of empty-beating hypertrophied hearts during valvular surgery.

Original languageEnglish
Pages (from-to)69-76
Number of pages8
JournalEuropean Journal of Cardio-thoracic Surgery
Volume35
Issue number1
DOIs
StatePublished - Jan 1 2009

Fingerprint

Perfusion
Energy Metabolism
Reperfusion
Phosphocreatine
Adenosine Triphosphate
Magnetic Resonance Spectroscopy
Swine

Keywords

  • Antegrade perfusion
  • Empty-beating
  • Energy metabolism
  • Hypertrophied heart
  • Myocardial oxygenation
  • Retrograde perfusion

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Alternate antegrade/retrograde perfusion : an effective technique to preserve hypertrophied hearts during valvular surgery. / Wang, Jian; Liu, Hongyu; Salerno, Tomas; Tomanek, Boguslaw; Summers, Randy; Deslauriers, Roxanne; Arora, Rakesh C.; Tian, Ganghong.

In: European Journal of Cardio-thoracic Surgery, Vol. 35, No. 1, 01.01.2009, p. 69-76.

Research output: Contribution to journalArticle

Wang, Jian ; Liu, Hongyu ; Salerno, Tomas ; Tomanek, Boguslaw ; Summers, Randy ; Deslauriers, Roxanne ; Arora, Rakesh C. ; Tian, Ganghong. / Alternate antegrade/retrograde perfusion : an effective technique to preserve hypertrophied hearts during valvular surgery. In: European Journal of Cardio-thoracic Surgery. 2009 ; Vol. 35, No. 1. pp. 69-76.
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abstract = "Objective: Continuous antegrade perfusion (AP) may interfere with surgical precision. Continuous retrograde perfusion (RP), on the other hand, cannot sustain the empty-beating hypertrophied hearts. Therefore, alternate antegrade/retrograde perfusion (AA/RP) may be a rational technique to preserve the hypertrophied hearts. This study is to determine whether AA/RP could maintain myocardial energy metabolism, oxygenation, and contractile function of the empty-beating hypertrophied hearts. Methods: Sixteen hypertrophied pig hearts were divided into four groups (n = 4 per group). Group I and II underwent an 80-min AA/RP (four 10-min APs and four 10-min RPs), followed by a 20-min reperfusion. Group III and IV were subjected to an 80-min AP and 20-min reperfusion and used as a control. Energy metabolism was evaluated in group I and III using magnetic resonance spectroscopy. Myocardial oxygenation (MO) was assessed in group II and IV using near infrared spectroscopic imaging. Results: During 80-min AA/RP, four episodes of RP resulted in a significant decrease in myocardial phosphocreatine (PCr) and MO. The subsequent AP, however, resulted in complete recovery of the parameters. Moreover, myocardial adenosine triphosphate (ATP) remained at a normal level throughout the 80-min AA/RP. As expected, hearts in groups III and IV showed normal level of myocardial PCr, ATP, and MO throughout protocol. Finally, hearts in all four groups showed similar contractile function during reperfusion. Conclusions: AA/RP with four 10-min intervals of AP and RP sustained normal myocardial energy metabolism, oxygenation, and contractile function of empty-beating hypertrophied hearts. We conclude that AA/RP is an effective technique for preservation of empty-beating hypertrophied hearts during valvular surgery.",
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T2 - an effective technique to preserve hypertrophied hearts during valvular surgery

AU - Wang, Jian

AU - Liu, Hongyu

AU - Salerno, Tomas

AU - Tomanek, Boguslaw

AU - Summers, Randy

AU - Deslauriers, Roxanne

AU - Arora, Rakesh C.

AU - Tian, Ganghong

PY - 2009/1/1

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N2 - Objective: Continuous antegrade perfusion (AP) may interfere with surgical precision. Continuous retrograde perfusion (RP), on the other hand, cannot sustain the empty-beating hypertrophied hearts. Therefore, alternate antegrade/retrograde perfusion (AA/RP) may be a rational technique to preserve the hypertrophied hearts. This study is to determine whether AA/RP could maintain myocardial energy metabolism, oxygenation, and contractile function of the empty-beating hypertrophied hearts. Methods: Sixteen hypertrophied pig hearts were divided into four groups (n = 4 per group). Group I and II underwent an 80-min AA/RP (four 10-min APs and four 10-min RPs), followed by a 20-min reperfusion. Group III and IV were subjected to an 80-min AP and 20-min reperfusion and used as a control. Energy metabolism was evaluated in group I and III using magnetic resonance spectroscopy. Myocardial oxygenation (MO) was assessed in group II and IV using near infrared spectroscopic imaging. Results: During 80-min AA/RP, four episodes of RP resulted in a significant decrease in myocardial phosphocreatine (PCr) and MO. The subsequent AP, however, resulted in complete recovery of the parameters. Moreover, myocardial adenosine triphosphate (ATP) remained at a normal level throughout the 80-min AA/RP. As expected, hearts in groups III and IV showed normal level of myocardial PCr, ATP, and MO throughout protocol. Finally, hearts in all four groups showed similar contractile function during reperfusion. Conclusions: AA/RP with four 10-min intervals of AP and RP sustained normal myocardial energy metabolism, oxygenation, and contractile function of empty-beating hypertrophied hearts. We conclude that AA/RP is an effective technique for preservation of empty-beating hypertrophied hearts during valvular surgery.

AB - Objective: Continuous antegrade perfusion (AP) may interfere with surgical precision. Continuous retrograde perfusion (RP), on the other hand, cannot sustain the empty-beating hypertrophied hearts. Therefore, alternate antegrade/retrograde perfusion (AA/RP) may be a rational technique to preserve the hypertrophied hearts. This study is to determine whether AA/RP could maintain myocardial energy metabolism, oxygenation, and contractile function of the empty-beating hypertrophied hearts. Methods: Sixteen hypertrophied pig hearts were divided into four groups (n = 4 per group). Group I and II underwent an 80-min AA/RP (four 10-min APs and four 10-min RPs), followed by a 20-min reperfusion. Group III and IV were subjected to an 80-min AP and 20-min reperfusion and used as a control. Energy metabolism was evaluated in group I and III using magnetic resonance spectroscopy. Myocardial oxygenation (MO) was assessed in group II and IV using near infrared spectroscopic imaging. Results: During 80-min AA/RP, four episodes of RP resulted in a significant decrease in myocardial phosphocreatine (PCr) and MO. The subsequent AP, however, resulted in complete recovery of the parameters. Moreover, myocardial adenosine triphosphate (ATP) remained at a normal level throughout the 80-min AA/RP. As expected, hearts in groups III and IV showed normal level of myocardial PCr, ATP, and MO throughout protocol. Finally, hearts in all four groups showed similar contractile function during reperfusion. Conclusions: AA/RP with four 10-min intervals of AP and RP sustained normal myocardial energy metabolism, oxygenation, and contractile function of empty-beating hypertrophied hearts. We conclude that AA/RP is an effective technique for preservation of empty-beating hypertrophied hearts during valvular surgery.

KW - Antegrade perfusion

KW - Empty-beating

KW - Energy metabolism

KW - Hypertrophied heart

KW - Myocardial oxygenation

KW - Retrograde perfusion

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