Keeping the heart empty and beating: an alternative technique to preserve hypertrophied hearts during valvular surgery
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RESEARCH ARTICLE
Open Access
Keeping the heart empty and beating: an alternative technique to preserve hypertrophied hearts during valvular surgery Shangdian Liu1, Zonghong Liu1, Lulu Li2, Pengfei Liu2 and Hongyu Liu1*
Abstract Introduction: To determine whether keeping the heart empty and beating is an effective technique to preserve hypertrophied pig hearts, and to investigate the underlying mechanism. Methods: Ten Bama Miniature pigs with hypertrophied hearts were divided into 2 groups (n = 5 in each group). One group underwent normothermic normokalemic simultaneous perfusion (NNSP). The other group was subjected to normothermic hypermokalemic simultaneous perfusion (NHSP) and used as controls. Cardiac contractive function, myocardial energy metabolism and myocardial perfusion were assessed using magnetic resonance imaging. Western blot analysis was carried out to determine the expression of Troponin I (cTnI), Troponin T (cTnT), SM-MHC, Casapase-3 and PARP4. TUNEL assay was used to detect apoptotic cardiomyocytes. Results: Keeping the heart empty and beating with NNSP improved the preservation of contractile function in comparison with cardioplegic arrest using NHSP. No significant differences existed in the effects of NNSP and NHSP in maintaining myocardial energy metabolism. 13 % perfusion defects areas were found in one heart in the NHSP group, whereas none was found in all other hearts in both groups. The expressions of cTnI, cTnT, Casapase-3 and PARP4 in NHSP group were abundantly increased compared to NNSP group as measured by Western blotting. Conversely, the expression of SM-MHC in NHSP group was reduced compared with NNSP group. The number of TUNEL positive nuclei per mm2 area was significantly increased in NHSP group compared with NNSP group. Conclusions: Keeping the heart beating with NNSP is an alternative technique to preserve hypertrophied hearts during valvular surgery.
Background It is well acknowledged that to date cardiac surgery is the most effective therapeutic treatment for valve diseases [1]. For safe and effective valve surgery, adequate myocardial protection is considered to be an important aspect. Hypothermic cardioplegia techniques were applied and well accepted to induce myocardial protective effects by reducing oxygen consumption in the initial stage [2]. However, it was observed later that cardioplegia techniques could cause subsequent cardiac impairment, especially reperfusion injury [3], especially in patients with compromised cardiac function, such as severe myocardial hypertrophy, low ejection fraction, * Correspondence: [email protected] 1 Department of Cardiovascular Surgery, the First Affiliated Hospital of Harbin Medical University, 23 Youzheng Road, Harbin, Heilongjiang 150001, China Full list of author information is available at the end of the article
previous coronary revascularization and multiple valve pathologies [4–8]. Myocardial hypertrophy, accompanied with the development of perivascular and interstitial accumulation of connective tissue, directly deterio
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