Influence of Type of Surgery on the Occurrence of Parasympathetic Reinnervation After Cardiac Transplantation

Bernardi, Luciano; Valenti, Cinzia; Wdowczyck-Szulc, Joanna; Frey, Axel W.; Rinaldi, Mauro; Spadacini, Giammario; Passino, Claudio; Martinelli, Luigi; Viganò, Mario; Finardi, G

doi:10.1161/01.cir.97.14.1368

Cited by 68 publications

(73 citation statements)

References 33 publications

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“…They also showed that bicaval heart transplantation markedly increases the likelihood of autonomic reinnervation compared with standard cardiac transplantation. 20 The patients in our study had undergone standard cardiac transplantation.…”

Section: Discussionmentioning

confidence: 99%

Sympathetic Rhythmicity in Cardiac Transplant Recipients

Borne

Montano

Degaute³

et al. 1999

Circulation

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Background-Variability of R-R interval and muscle sympathetic nerve activity (MSNA) occurs predominantly at a low frequency (LF, Ϯ0.1 Hz) and a high frequency (HF, Ϯ0.25 Hz) in normal humans. Increased sympathetic drive in normal humans is associated with an increased LF component of the R-R interval and MSNA. Patients with severe heart failure have high sympathetic activity but decreased or absent LF power of both R-R and MSNA. We tested the hypothesis that this dysfunction in autonomic modulation in heart failure can be reversed by heart transplantation. Methods and Results-We performed spectral analysis of resting MSNA, R-R interval, and respiration in 9 patients with heart transplants, 9 chronic heart failure patients, and 9 normal control subjects, all closely matched for age, sex, and body mass index. MSNA (bursts per minute) was higher in patients with heart transplants (74Ϯ3) than either patients with heart failure (56Ϯ6) or normal subjects (40Ϯ4) (PϽ0.001). LF variability in the R-R interval was reduced in both heart transplant recipients and heart failure patients compared with the control subjects (PϽ0.01). The LF variability in MSNA was also nearly absent in the heart failure patients (PϽ0.01). However, the LF and HF oscillations in MSNA in patients with heart transplants were comparable to those evident in the control subjects. Conclusions-Cardiac transplantation does not reduce MSNA. However, LF oscillations in sympathetic activity are restored after transplantation such that the MSNA oscillatory profile is similar to that observed in normal subjects.

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Section: Discussionmentioning

confidence: 99%

Sympathetic Rhythmicity in Cardiac Transplant Recipients

Borne

Montano

Degaute³

et al. 1999

Circulation

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“…[1][2][3] These patients may also manifest slower oscillations in RR (0.03 to 0.15 Hz, lowfrequency [LF]), which are not mediated by the mechanical effects of respiration. These LF oscillations are a marker of functional sympathetic reinnervation of the sinus node, because they increase in amplitude during sinusoidal neck suction and are attenuated by ␤-blockade.…”

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confidence: 99%

“…These LF oscillations are a marker of functional sympathetic reinnervation of the sinus node, because they increase in amplitude during sinusoidal neck suction and are attenuated by ␤-blockade. 1 Reinnervation has been demonstrated mainly for sympathetic efferents 1,[3][4][5][6] and is of clinical importance, because it is accompanied by partial restoration of the heart-rate response to exercise. 7 Previous studies in control subjects and patients with cardiac transplants have demonstrated that direct recordings of sympathetic nerve traffic (muscle sympathetic nerve activity [MSNA]) exhibit LF and HF oscillatory components almost identical to those present in heart-rate variability.…”

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confidence: 99%

Differential Characteristics of Neural Circulatory Control

et al. 2001

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Background-Reappearance of low-frequency (LF) (Ϯ0.10 Hz) oscillations in RR interval (RR) after cardiac transplantation is indicative of sympathetic efferent reinnervation. We hypothesized that restored LF oscillations in RR in heart transplant recipients (HTRs) are linked to oscillations in muscle sympathetic nerve traffic (MSNA). Methods and Results-RR, RR variability, and MSNA were recorded 5Ϯ2 months (nϭ7, short-term HTRs) and 138Ϯ8 months (nϭ7, long-term HTRs) after heart transplantation and compared with matched hypertensive patients (nϭ7). A coherence function determined the coupling between LF oscillations in MSNA and RR. RR variance did not differ between short-term and long-term HTRs. However, LF variability was only 1Ϯ0.5 ms 2 in the short-term HTRs but was 15Ϯ8 ms 2 in the long-term HTRs (PϽ0.05). Normalized LF variability was also higher in the long-term HTRs (40Ϯ14 normalized unites) versus the short-term HTRs (6Ϯ3 normalized united, PϽ0.05) but did not differ from the LF variability of the hypertensive patients. Long-term HTRs were taking less cyclosporine (PϽ0.01) but had higher MSNA than the short-term HTRs (62Ϯ7 versus 31Ϯ7 burst/min, respectively, PϽ0.05). Coherence between LF oscillations in MSNA and RR was similar in the long-term HTRs (0.59Ϯ0.11) and the hypertensive patients (0.60Ϯ0.07) and was 3-fold greater than in the short-term HTRs (0.20Ϯ0.06, PϽ0.05). Conclusions-Cardiac reinnervation after long-term heart transplantation is characterized by a restoration of the coherence between LF oscillations in RR and MSNA. Higher MSNA in long-term than in short-term HTRs suggests that time elapsed after cardiac transplantation may be a major determinant of sympathetic excitation in heart transplant recipients.

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“…With the bicaval anastomosis technique, the recipient's heart is totally excised and there is no innervated recipient atrial tissue to potentially interfere with the process of reinnervation. 26 While the evidence for limited cardiac reinnervation is intriguing, a careful review of this subject concluded that functional reinnervation of the transplanted heart rarely, if ever, occurs. 1 Accordingly, it is anticipated that changes in HR, normally produced by altered cardiac autonomic tone, are absent in this unique type of patient and a relatively stable HR is expected.…”

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confidence: 99%

“…Such changes in HR are of particular interest when considered in the context of the controversy regarding reinnervation of the transplanted organ. 1 As the patient had undergone transplantation only five months previously, and, as reinnervation of the transplanted heart (when demonstrable) is not evident before one year after transplantation, 14,18,19,26 the response is unlikely to have been mediated by reflex activation of the sinoatrial (SA) node directly via the central nervous system. Because the patient underwent transplantation using the bicaval anastomosis technique, changes in donor HR could not have been mediated by altered rate of contraction of remnant innervated atrial tissue.…”

mentioning

confidence: 99%

Decreased heart rate and blood pressure in a recent cardiac transplant patient after spinal anesthesia

Allard

Hatzakorzian

Deschamps

et al. 2004

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To describe the cardiovascular effects of neuraxial blockade in a heart transplant patient.C Cl li in ni ic ca al l f fe ea at tu ur re es s: : A 69-yr-old 70-kg male underwent orthotopic heart transplant (bicaval anastomosis technique) for ischemic cardiomyopathy. Five months after transplantation, the patient underwent a transurethral bladder tumour resection under spinal anesthesia. Two millilitres of bupivacaine 0.75% (15 mg) were injected intrathecally at L 3-4 and the patient remained seated for approximately 20 sec prior to assuming the lithotomy position. Subsequently, both blood pressure (BP) and heart rate (HR) diminished gradually (BP and HR immediately pre-spinal: 113 mmHg (mean arterial pressure) and 92 beats·min -1 , respectively; nadir BP and HR: 94 mmHg (16.8% decrease) 30 min postspinal and 73 beats·min -1 (20.7% decrease) 40 min postspinal, respectively). HR and mean BP were highly correlated (r = 0.9410, P < 0.0001, R 2 = 0.8854). The dermatome level of neuraxial anesthesia, determined by sensitivity to pin prick, was T 8 (five minutes) and T 6 (ten minutes) postinjection of spinal anesthetic. Control patients (n = 10) undergoing elective urological procedures with identical anesthesia management demonstrated very similar cardiovascular responses.

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Influence of Type of Surgery on the Occurrence of Parasympathetic Reinnervation After Cardiac Transplantation

Cited by 68 publications

References 33 publications

Sympathetic Rhythmicity in Cardiac Transplant Recipients

Sympathetic Rhythmicity in Cardiac Transplant Recipients

Differential Characteristics of Neural Circulatory Control

Decreased heart rate and blood pressure in a recent cardiac transplant patient after spinal anesthesia

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