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THE JOURNAL OF CARDIOVASCULAR SURGERY

A Journal on Cardiac, Vascular and Thoracic Surgery


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The Journal of Cardiovascular Surgery 2018 Jan 09

DOI: 10.23736/S0021-9509.18.10087-5

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Development of a porcine beating-heart model of self-myocardial retroperfusion: evaluation of hemodynamic and cardiac responses to ischemia and clinical applications

Daniel GRANDMOUGIN 1, 2 , Jean-Mathieu CASSE 3, Antoine CHALON 1, Yun LUO 1, 4, Aude FALANGA 1, Vanessa MARIE 1, Fréderique GROUBATCH-JOINEAU 1, Brice MOURER 1, Marie GRANDMOUGIN 5, David GRANDMOUGIN 6, Guillaume GAUCHOTTE 3, Juan-Pablo MAUREIRA 1,2, Nguyen TRAN 1

1 School of Surgery, Université de Lorraine, Lorraine, France; 2 Department of Cardiovascular Surgery, CHRU Nancy, Nancy, France; 3 Department of Cytology and Pathology, CHRU Nancy, Nancy, France; 4 Unité INSERM, Bordeaux, France; 5 Faculté de Pharmacie, Université de Lorraine, Lorraine, France; 6 Faculté de Lettres et Sciences Humaines, Université de Lorraine, Lorraine, France


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BACKGROUND: Retrograde perfusion into the coronary sinus is used to deliver cardioplegia. We developed an in-vivo porcine beating-heart model of self-myocardial retroperfusion (SMR) using the venous route to supply myocardial oxygenation and sought to assess hemodynamic and cardiac responses triggered by SMR before and after a prolonged occlusion of the LAD.
METHODS: A bypass-line between the ascending aorta and the coronary sinus was made to perform a selective retrograde perfusion of the great cardiac vein with oxygenated blood (SMR). A Control group (n=6) was assigned to collect baseline data, and an SMR group (n=6) was dedicated to undergo SMR with occlusion of LAD for 240 minutes. Cardiac output (CO), maximal pressure in the LV (Pmax in-LV), stroke volume (SV), left ventricular ejection fraction (LVEF), diastolic durations, heart rate, and arterial systemic pressure were evaluated with conductance catheters for the following periods: basal (before SMR), SMR with patent LAD, and SMR with occluded LAD. In order to assess peripheral perfusion, patterns of sublingual microcirculation were analyzed. At the end of the procedures, the hearts were harvested for histology.
RESULTS: Echographic LVEF evaluation was affected by sternotomy, but conductance catheter evaluation was not. Following pericardiotomy, CO decreased by 7.51% (P < 0.05). SMR with patent LAD showed inotropic properties with improvements in CO, SV, Pmax in-LV and LVEF (P < 0.0001). Following LAD occlusion, SMR supplied myocardial oxygenation with hemodynamic compensation and preserved the peripheral perfusion. Histology confirmed no signs of infarct.
CONCLUSIONS: SMR showed capacities to produce inotropic effects and protect against ischemia, opening interesting perspectives.


KEY WORDS: Self Myocardial Retroperfusion (SMR) - Coronary circulation - Hemodynamics - Ischemia - Conductance catheter - Left azygos vein

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Publication History

Article first published online: January 9, 2018
Manuscript accepted: January 8, 2018
Manuscript revised: October 5, 2017
Manuscript received: June 27, 2017

Cite this article as

Grandmougin D, Casse JM, Chalon A, Luo Y, Falanga A, Marie V, et al. Development of a porcine beating-heart model of self-myocardial retroperfusion: evaluation of hemodynamic and cardiac responses to ischemia and clinical applications. J Cardiovasc Surg 2018 Jan 09. DOI: 10.23736/S0021-9509.18.10087-5

Corresponding author e-mail

d.grandmougin@chu-nancy.fr