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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