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

Wang, Jian; Liu, Hongyu; Salerno, Tomás A.; Tomanek, Bogusław; Summers, Randy; Deslauriers, Roxanne; Arora, Rakesh C.; Tian, Ganghong

doi:10.1016/j.ejcts.2008.10.015

Cited by 6 publications

(2 citation statements)

References 22 publications

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“…Simultaneous perfusion aims to relieve the inadequate blood distribution beyond a stenotic coronary artery in one way perfusion, flush air out of the coronary system and provide a more homogeneous distribution of blood [20,23-25]. Wang et al [38,39] found that retrograde perfusion could not provide adequate protection to the hypertrophied pig heart in beating heart surgery, and compared with the antegrade perfusion, simultaneous perfusion led to slightly impaired myocardial oxygenation and energy metabolism. So far, there is no general agreement as to …”

Section: One Way Perfusion and Simultaneous Antegrade And Retrograde mentioning

confidence: 98%

On-pump Beating Heart Surgery

Lin

2011

Heart, Lung and Circulation

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Section: One Way Perfusion and Simultaneous Antegrade And Retrograde mentioning

confidence: 98%

On-pump Beating Heart Surgery

Lin

2011

Heart, Lung and Circulation

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“…TEE was used to evaluate the aortic valve during the procedures and to guide de-airing. Antegrade perfusion is more physiological than retrograde perfusion, and retrograde perfusion does not provide adequate protection to the hypertrophied heart in an empty and beating state [21]. Nevertheless, the postoperative recovery of patients using retrograde perfusion in the present and other studies [22-24] was excellent.…”

Section: Discussionmentioning

confidence: 63%

Surgical correction of ruptured aneurysms of the sinus of Valsalva using on-pump beating-heart technique

Lin

2010

J Cardiothorac Surg

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BackgroundRupture of aneurysms of the sinus of Valsalva results in abrupt onset of congestive heart failure. On-pump beating-heart surgery may reduce cardiac impairment by maintaining coronary blood flow and avoiding cardioplegia. Herein, we report the operative correction of thirty-one patients of ruptured aneurysms of the sinus of Valsalva, using the on-pump beating-heart technique.MethodsThirty-one patients with ruptured aneurysms of the sinus of Valsalva underwent operative corrections using the on-pump beating-heart technique. In patients with fistula diameter less than 1 cm and no aortic regurgitation, the aorta was unclamped throughout cardiopulmonary bypass(CPB) while receiving antegrade heart perfusion. In remainder of patients, retrograde perfusion was used.ResultsAfter intracardiac manipulation was complete and the nasopharyngeal temperature was raised to 36-37°C, the patients were smoothly weaned off CPB. There were no early or late postoperative deaths. All patients were in New York Heart Association functional class I at follow-up (range, 0.5-1 year). Mild-to-moderate aortic valve regurgitation was observed in one patient. No recurrence of the left-to-right shunt from ruptured aneurysms of the sinus of Valsalva was observed.ConclusionsBeating heart on pump allows adequate examination of the aortic lesion under near-physiologic conditions, allows decrease in ischemia-reperfusion injury and potentially decreases the risk of serious or fatal rhythm disturbances. On-pump beating-heart technique for repair of ruptured aneurysm of sinus of Valsalva is feasible and promising. Antegrade heart perfusion is suitable for patients with a fistula diameter <1 cm and no aortic regurgitation, and retrograde perfusion is suitable for the others.

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Preservation of Myocardial Perfusion and Function by Keeping Hypertrophied Heart Empty and Beating for Valve Surgery: An In Vivo MR Study of Pig Hearts

Wang

Xiang

Deng

et al. 2017

BioMed Research International

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Objectives. Normothermic hyperkalemic cardioplegia arrest (NHCA) may not effectively preserve hypertrophied myocardium during open-heart surgery. Normothermic normokalemic beating perfusion (NNBP), keeping hearts empty-beating, was utilized as an alternative to evaluate its cardioprotective role. Materials and Methods. Twelve hypertrophied pig hearts at 58.6 ± 7.2 days after ascending aorta banding underwent NNBP and NHCA, respectively. Near infrared myocardial perfusion imaging with indocyanine green (ICG) was conducted to assess myocardial perfusion. Left ventricular (LV) contractile function was assessed by cine MRI. TUNEL staining and western blotting for caspase-3 cleavage and cardiac troponin I (cTnI) degradation were conducted in LV tissue samples. Results. Ascending aortic diameter was reduced by 52.7% ± 0.4% at approximately fifty-eight days after banding. LV wall thickness was significantly higher in aorta banding than in sham operation. Myocardial blood flow reflected by maximum ICG absorbance value was markedly higher in NNBP than in NHCA. The amount of apoptotic cardiomyocyte was significantly lower in NNBP than in NHCA. NNBP alleviated caspase-3 cleavage and cTnI degradation associated with NHCA. NNBP displayed a substantially increased postoperative ejection fraction relative to NHCA. Conclusions. NNBP was better than NHCA in enhancing myocardial perfusion, inhibiting cardiomyocyte apoptosis, and preserving LV contractile function for hypertrophied hearts.

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

Cited by 6 publications

References 22 publications

On-pump Beating Heart Surgery

On-pump Beating Heart Surgery

Surgical correction of ruptured aneurysms of the sinus of Valsalva using on-pump beating-heart technique

Preservation of Myocardial Perfusion and Function by Keeping Hypertrophied Heart Empty and Beating for Valve Surgery: An In Vivo MR Study of Pig Hearts

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