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Keeran KJ, Jeffries KR, Zetts AD, Taylor J, Kozlov S, Hunt TJ. A Chronic Cardiac Ischemia Model in Swine Using an Ameroid Constrictor. J Vis Exp 2017. [PMID: 29053673 PMCID: PMC5752388 DOI: 10.3791/56190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Cardiovascular disease remains the number one cause of mortality in the United States. There are numerous approaches to treating these diseases, but regardless of the approach, an in vivo model is needed to test each treatment. The pig is one of the most used large animal models for cardiovascular disease. Its heart is very similar in anatomy and function to that of a human. The ameroid placement technique creates an ischemic area of the heart, which has many useful applications in studying myocardial infarction. This model has been used for surgical research, pharmaceutical studies, imaging techniques, and cell therapies. There are several ways of inducing an ischemic area in the heart. Each has its advantages and disadvantages, but the placement of an ameroid constrictor remains the most widely used technique. The main advantages to using the ameroid are its prevalence in existing research, its availability in various sizes to accommodate the anatomy and size of the vessel to be constricted, the surgery is a relatively simple procedure, and the post-operative monitoring is minimal, since there are no external devices to maintain. This paper provides a detailed overview of the proper technique for the placement of the ameroid constrictor.
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Affiliation(s)
- Karen J Keeran
- Animal Surgery and Resources Core, National Heart, Lung, and Blood Institute, National Institutes of Health
| | - Kenneth R Jeffries
- Animal Surgery and Resources Core, National Heart, Lung, and Blood Institute, National Institutes of Health
| | - Arthur D Zetts
- Animal Surgery and Resources Core, National Heart, Lung, and Blood Institute, National Institutes of Health
| | - Joni Taylor
- Animal Surgery and Resources Core, National Heart, Lung, and Blood Institute, National Institutes of Health
| | - Shawn Kozlov
- Animal Surgery and Resources Core, National Heart, Lung, and Blood Institute, National Institutes of Health
| | - Timothy J Hunt
- Animal Surgery and Resources Core, National Heart, Lung, and Blood Institute, National Institutes of Health;
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Iwanski J, Knapp SM, Avery R, Oliva I, Wong RK, Runyan RB, Khalpey Z. Clinical outcomes meta-analysis: measuring subendocardial perfusion and efficacy of transmyocardial laser revascularization with nuclear imaging. J Cardiothorac Surg 2017; 12:37. [PMID: 28526044 PMCID: PMC5438520 DOI: 10.1186/s13019-017-0602-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 05/10/2017] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Randomized and nonrandomized clinical trials have tried to assess whether or not TMR patients experience an increase in myocardial perfusion. However there have been inconsistencies reported in the literature due to the use of different nuclear imaging modalities to test this metric. The primary purpose of this meta-analysis was to determine whether SPECT, MUGA and PET scans demonstrate changes in myocardial perfusion between lased and non-lased subjects and whether laser type affects myocardial perfusion. The secondary purpose was to examine the overall effect of laser therapy on clinical outcomes including survival, hospital re-admission and angina reduction. METHODS Sixteen studies were included in the primary endpoint analysis after excluding all other non-imaging TMR papers. Standardized mean difference was used as the effect size for all quantitative outcomes and log odds ratio was used as the effect size for all binary outcomes. RESULTS Statistically significant improvements in myocardial perfusion were observed between control and treatment groups in myocardial perfusion at 6-month follow up using PET imaging with a porcine model. However non-significant differences were observed in patients at 3 and 12 months using SPECT, PET or MUGA scans. Both CO2 and Ho:YAG laser systems demonstrated an increase in myocardial perfusion however this effect was not statistically significant. In addition both laser types displayed statistically significant decreases in patient angina at 3, 6 and 12 months but non-significant increases in survival rates and decreases in hospital re-admissions. CONCLUSION In order to properly assess myocardial perfusion in TMR subjects, subendocardial perfusion needs to be analyzed via nuclear imaging. PET scans can provide this level of sensitivity and should be utilized in future studies to monitor and detect perfusion changes in lased and non-lased subjects.
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Affiliation(s)
- Jessika Iwanski
- Department of Medical Pharmacology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Shannon M Knapp
- BIO5 Institute, Statistics Consulting Lab, University of Arizona, Tucson, AZ, USA
| | - Ryan Avery
- Department of Nuclear Medicine, Banner University Medical Center, Medical Imaging, Tucson, AZ, USA
| | - Isabel Oliva
- Department of Nuclear Medicine, Banner University Medical Center, Medical Imaging, Tucson, AZ, USA
| | - Raymond K Wong
- Department of Medical Pharmacology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Raymond B Runyan
- Department of Cellular and Molecular Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Zain Khalpey
- Department of Medical Pharmacology, University of Arizona College of Medicine, Tucson, AZ, USA. .,Division of Cardiothoracic Surgery, Department of Surgery, University of Arizona, Tucson, AZ, USA. .,Division of Cardiothoracic Surgery, Regenerative Medicine, Cellular & Molecular Medicine, University of Arizona College of Medicine, 1656 E. Mabel St, Rm 120, Medical Research Building, Tucson, AZ 85724, USA.
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Robinson AM, Stock SR, Soriano C, Xiao X, Richter CP. Using synchrotron X-ray phase-contrast micro-computed tomography to study tissue damage by laser irradiation. Lasers Surg Med 2016; 48:866-877. [PMID: 27551862 DOI: 10.1002/lsm.22571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2016] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVE The aim of this study was to determine if X-ray micro-computed tomography could be used to locate and characterize tissue damage caused by laser irradiation and to describe its advantages over classical histology for this application. STUDY DESIGN/MATERIALS AND METHODS A surgical CO2 laser, operated in single pulse mode (100 milliseconds) at different power settings, was used to ablate different types of cadaveric animal tissues. Tissue samples were then harvested and imaged with synchrotron X-ray phase-contrast and micro-computed tomography to generate stacks of virtual sections of the tissues. Subsequently, Fiji (ImageJ) software was used to locate tissue damage, then to quantify volumes of laser ablation cones and thermal coagulation damage from 3D renderings of tissue image stacks. Visual comparisons of tissue structures in X-ray images with those visible by classic light microscopy histology were made. RESULTS We demonstrated that micro-computed tomography could be used to rapidly identify areas of surgical laser ablation, vacuolization, carbonization, and thermally coagulated tissue. Quantification and comparison of the ablation crater, which represents the volume of ablated tissue, and the thermal coagulation zone volumes were performed faster than we could by classical histology. We demonstrated that these procedures can be performed on fresh hydrated and non-sectioned plastic embedded tissue. CONCLUSION We demonstrated that the application of non-destructive micro-computed tomography to the visualization and analysis of laser induced tissue damage without tissue sectioning is possible. This will improve evaluation of new surgical lasers and their corresponding effect on tissues. Lasers Surg. Med. 48:866-877, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Alan M Robinson
- Department of Otolaryngology Head and Neck Surgery, Northwestern University, 303 E. Chicago Ave., Searle 12-561, Chicago 60611, Illinois
| | - Stuart R Stock
- Department of Cell and Molecular Biology, Northwestern University Feinberg School of Medicine, Chicago 60611, Illinois
| | - Carmen Soriano
- Advanced Photon Source, Argonne National Laboratory, 9700 South Cass Ave., Argonne 60439, Illinois
| | - Xianghui Xiao
- Advanced Photon Source, Argonne National Laboratory, 9700 South Cass Ave., Argonne 60439, Illinois
| | - Claus-Peter Richter
- Department of Otolaryngology Head and Neck Surgery, Northwestern University, 303 E. Chicago Ave., Searle 12-561, Chicago 60611, Illinois. .,Department of Biomedical Engineering, Northwestern University, 2145 Sheridan Road, Tech E310, Evanston 60208, Illinois. .,The Hugh Knowles Center, Department of Communication Sciences and Disorders, Northwestern University, Frances Searle Building, 2240 Campus Drive, Evanston 60208, Illinois.
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Iwanski J, Wong RK, Larson DF, Ferng AS, Runyan RB, Goldstein S, Khalpey Z. Remodeling an infarcted heart: novel hybrid treatment with transmyocardial revascularization and stem cell therapy. SPRINGERPLUS 2016; 5:738. [PMID: 27376006 PMCID: PMC4909685 DOI: 10.1186/s40064-016-2355-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 05/17/2016] [Indexed: 01/04/2023]
Abstract
Transmyocardial revascularization (TMR) has emerged as an additional therapeutic option for patients suffering from diffuse coronary artery disease (CAD), providing immediate angina relief. Recent studies indicate that the volume of surgical cases being performed with TMR have been steadily rising, utilizing TMR as an adjunctive therapy. Therefore the purpose of this review is to provide an up-to-date appreciation of the current state of TMR and its future developmental directions on CAD treatment. The current potential of this therapy focuses on the implementation of stem cells, in order to create a synergistic angiogenic effect while increasing myocardial repair and regeneration. Although TMR procedures provide increased vascularization within the myocardium, patients suffering from ischemic cardiomyopathy may not benefit from angiogenesis alone. Therefore, the goal of introducing stem cells is to restore the functional state of a failing heart by providing these cells with a favorable microenvironment that will enhance stem cell engraftment.
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Affiliation(s)
- Jessika Iwanski
- Department of Pharmacology, University of Arizona College of Medicine, Tucson, AZ USA ; Department of Surgery, Division of Cardiothoracic Surgery, University of Arizona College of Medicine, P.O. Box 245071, 1501N. Campbell Avenue, Tucson, AZ 85724-5071 USA
| | - Raymond K Wong
- Department of Pharmacology, University of Arizona College of Medicine, Tucson, AZ USA
| | - Douglas F Larson
- Department of Surgery, Division of Cardiothoracic Surgery, University of Arizona College of Medicine, P.O. Box 245071, 1501N. Campbell Avenue, Tucson, AZ 85724-5071 USA
| | - Alice S Ferng
- Department of Surgery, Division of Cardiothoracic Surgery, University of Arizona College of Medicine, P.O. Box 245071, 1501N. Campbell Avenue, Tucson, AZ 85724-5071 USA ; Department of Physiological Sciences, University of Arizona College of Medicine, Tucson, AZ USA
| | - Raymond B Runyan
- Department of Cellular and Molecular Medicine, University of Arizona College of Medicine, Tucson, AZ USA
| | | | - Zain Khalpey
- Department of Surgery, Division of Cardiothoracic Surgery, University of Arizona College of Medicine, P.O. Box 245071, 1501N. Campbell Avenue, Tucson, AZ 85724-5071 USA ; Department of Physiological Sciences, University of Arizona College of Medicine, Tucson, AZ USA ; Banner University Medical Center, 1501N. Campbell Avenue, Room 4302A, Tucson, AZ 85724 USA ; Medical Research Building, 1656 E. Mabel St, Rm 120, Tucson, AZ USA
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Transmyocardial Revascularization Enhances Bone Marrow Stem Cell Engraftment in Infarcted Hearts Through SCF—C-kit and SDF-1—CXCR4 Signaling Axes. Stem Cell Rev Rep 2014; 11:332-46. [DOI: 10.1007/s12015-014-9571-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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