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Greiner J, Schiatti T, Kaltenbacher W, Dente M, Semenjakin A, Kok T, Fiegle DJ, Seidel T, Ravens U, Kohl P, Peyronnet R, Rog-Zielinska EA. Consecutive-Day Ventricular and Atrial Cardiomyocyte Isolations from the Same Heart: Shifting the Cost-Benefit Balance of Cardiac Primary Cell Research. Cells 2022; 11:233. [PMID: 35053351 PMCID: PMC8773758 DOI: 10.3390/cells11020233] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 02/04/2023] Open
Abstract
Freshly isolated primary cardiomyocytes (CM) are indispensable for cardiac research. Experimental CM research is generally incompatible with life of the donor animal, while human heart samples are usually small and scarce. CM isolation from animal hearts, traditionally performed by coronary artery perfusion of enzymes, liberates millions of cells from the heart. However, due to progressive cell remodeling following isolation, freshly isolated primary CM need to be used within 4-8 h post-isolation for most functional assays, meaning that the majority of cells is essentially wasted. In addition, coronary perfusion-based isolation cannot easily be applied to human tissue biopsies, and it does not straightforwardly allow for assessment of regional differences in CM function within the same heart. Here, we provide a method of multi-day CM isolation from one animal heart, yielding calcium-tolerant ventricular and atrial CM. This is based on cell isolation from cardiac tissue slices following repeated (usually overnight) storage of the tissue under conditions that prolong CM viability beyond the day of organ excision by two additional days. The maintenance of cells in their near-native microenvironment slows the otherwise rapid structural and functional decline seen in isolated CM during attempts for prolonged storage or culture. Multi-day slice-based CM isolation increases the amount of useful information gained per animal heart, improving reproducibility and reducing the number of experimental animals required in basic cardiac research. It also opens the doors to novel experimental designs, including exploring same-heart regional differences.
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Affiliation(s)
- Joachim Greiner
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg-Bad Krozingen and Faculty of Medicine, Albert-Ludwig University of Freiburg, 79110 Freiburg im Breisgau, Germany
| | - Teresa Schiatti
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg-Bad Krozingen and Faculty of Medicine, Albert-Ludwig University of Freiburg, 79110 Freiburg im Breisgau, Germany
| | - Wenzel Kaltenbacher
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg-Bad Krozingen and Faculty of Medicine, Albert-Ludwig University of Freiburg, 79110 Freiburg im Breisgau, Germany
| | - Marica Dente
- Department of Experimental and Clinical Medicine, Division of Physiology, University of Florence, 50134 Florence, Italy
| | - Alina Semenjakin
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg-Bad Krozingen and Faculty of Medicine, Albert-Ludwig University of Freiburg, 79110 Freiburg im Breisgau, Germany
| | - Thomas Kok
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg-Bad Krozingen and Faculty of Medicine, Albert-Ludwig University of Freiburg, 79110 Freiburg im Breisgau, Germany
| | - Dominik J Fiegle
- Institute of Cellular and Molecular Physiology, Friedrich-Alexander-University of Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Thomas Seidel
- Institute of Cellular and Molecular Physiology, Friedrich-Alexander-University of Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Ursula Ravens
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg-Bad Krozingen and Faculty of Medicine, Albert-Ludwig University of Freiburg, 79110 Freiburg im Breisgau, Germany
| | - Peter Kohl
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg-Bad Krozingen and Faculty of Medicine, Albert-Ludwig University of Freiburg, 79110 Freiburg im Breisgau, Germany
- CIBSS Centre for Integrative Biological Signalling Studies, University of Freiburg, 79110 Freiburg im Breisgau, Germany
| | - Rémi Peyronnet
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg-Bad Krozingen and Faculty of Medicine, Albert-Ludwig University of Freiburg, 79110 Freiburg im Breisgau, Germany
| | - Eva A Rog-Zielinska
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg-Bad Krozingen and Faculty of Medicine, Albert-Ludwig University of Freiburg, 79110 Freiburg im Breisgau, Germany
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Kim HR, Jung SH, Yang J, Kim MS, Yun TJ, Kim JJ, Lee JW. The Effect of Supplemental Cardioplegia Infusion before Anastomosis in Patients Undergoing Heart Transplantation with Long Ischemic Times. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 53:375-380. [PMID: 33046664 PMCID: PMC7721527 DOI: 10.5090/kjtcs.19.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 08/18/2020] [Accepted: 08/18/2020] [Indexed: 11/30/2022]
Abstract
Background Prolonged ischemic time is a risk factor for primary graft dysfunction in patients who undergo heart transplantation. We investigated the effect of a supplemental cardioplegia infusion before anastomosis in patients with long ischemic times. Methods We identified 236 consecutive patients who underwent orthotopic heart transplantation between February 2010 and December 2014. Among them, the patients with total ischemic times of longer than 3 hours (n=59) were categorized based on whether they were administered a complementary cardioplegia solution (CPS) immediately before implantation (CPS+, n=30; CPS−, n=29). Results The mean total ischemic times in the CPS+ and CPS− groups were 238.1±30.1 minutes and 230.1±28.2 minutes, respectively (p=0.3). The incidence of left ventricular primary graft dysfunction (CPS+, n=6 [20.0%]; CPS−, n=5 [17.2%]; p=0.79) was comparable between the groups. In the Kaplan-Meier survival analysis, no significant difference in overall survival at 5 years was observed between the CPS+ and CPS− groups (83.1%±6.9% vs. 89.7%±5.7%, respectively; log-rank p=0.7). No inter-group differences in early mortality (CPS+, n=0; CPS−, n=1 [3.4%]; p=0.98) or complications were observed. Conclusion The additional infusion of a cardioplegia solution immediately before implantation in patients with longer ischemic times is a simple, reproducible, and safe procedure. However, we did not observe benefits of this strategy in the present study.
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Affiliation(s)
- Hong Rae Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Ho Jung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Junho Yang
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
| | - Min Su Kim
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Tae-Jin Yun
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Joong Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Won Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Whittaker A, Aboughdir M, Mahbub S, Ahmed A, Harky A. Myocardial protection in cardiac surgery: how limited are the options? A comprehensive literature review. Perfusion 2020; 36:338-351. [DOI: 10.1177/0267659120942656] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
For patients undergoing cardiopulmonary bypass, myocardial protection is a key for successful recovery and improved outcomes following cardiac surgery that requires cardiac arrest. Different solutions, components and modes of delivery have evolved over the last few decades to optimise myocardial protection. These include cold and warm and blood and crystalloid solution through antegrade, retrograde or combined cardioplegia delivery approach. However, each method has its own advantages and disadvantages, posing a challenge to establish a gold-standard cardioplegic solution with an optimised mode of delivery for enhanced myocardial protection during cardiac surgery. The aim of this review is to provide a brief history of the development of cardioplegia, explain the electrophysiological concepts behind myocardial protection in cardioplegia, analyse the current literature and summarise existing evidence that warrants the use of varying cardioplegic techniques. We provide a comprehensive and comparative overview of the effectiveness of each technique in achieving optimal cardioprotection and propose novel techniques for optimising myocardial protection in the future.
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Affiliation(s)
- Abigail Whittaker
- Department of Medicine, St George’s, University of London, London, UK
| | - Maryam Aboughdir
- Department of Medicine, St George’s, University of London, London, UK
- Department of Medicine, Imperial College London, London, UK
| | - Samiha Mahbub
- Department of Medicine, St George’s, University of London, London, UK
| | - Amna Ahmed
- Department of Medicine, Imperial College London, London, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
- School of Medicine, University of Liverpool, Liverpool, UK
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Li Y, Guo S, Liu G, Yuan Y, Wang W, Zheng Z, Hu S, Ji B. Three Preservation Solutions for Cold Storage of Heart Allografts: A Systematic Review and Meta-Analysis. Artif Organs 2015; 40:489-96. [PMID: 26526678 DOI: 10.1111/aor.12585] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Yongnan Li
- Department of Cardiopulmonary Bypass; State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College; Beijing China
- Department of Cardiac Surgery; Lanzhou University Second Hospital; Lanzhou China
| | - Shasha Guo
- Department of Cardiopulmonary Bypass; State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College; Beijing China
| | - Gang Liu
- Department of Cardiopulmonary Bypass; State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College; Beijing China
| | - Yuan Yuan
- Department of Cardiopulmonary Bypass; State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College; Beijing China
| | - Wei Wang
- Department of Cardiac Surgery; State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College; Beijing China
| | - Zhe Zheng
- Department of Cardiac Surgery; State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College; Beijing China
| | - Shengshou Hu
- Department of Cardiac Surgery; State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College; Beijing China
| | - Bingyang Ji
- Department of Cardiopulmonary Bypass; State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College; Beijing China
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Minasian SM, Galagudza MM, Dmitriev YV, Karpov AA, Vlasov TD. Preservation of the donor heart: from basic science to clinical studies. Interact Cardiovasc Thorac Surg 2014; 20:510-9. [PMID: 25538253 DOI: 10.1093/icvts/ivu432] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The methods of donor heart preservation are aimed at minimizing graft dysfunction caused by ischaemia-reperfusion injury (IRI) which inevitably occurs during the ex vivo transport interval. At present, the standard technique of heart preservation is cardiac arrest followed by static cold storage in a crystalloid heart preservation solution (HPS). This technique ensures an acceptable level of heart protection against IRI for <6 h. In clinical trials, comparable levels of myocardial protection against IRI were provided by various HPSs. The growing shortage of donor hearts is one of the major factors stimulating the development of new techniques of heart preservation. Here, we summarize new HPS formulations and provide a focus for optimization of the composition of existing HPSs. Such methods of donor heart preservation as machine perfusion, preservation at sub-zero temperature and oxygen persufflation are also discussed. Furthermore, we review experimental data showing that pre- and post-conditioning of the cardiac graft can improve its function when used in combination with cold storage. The evidence on the feasibility of cardiac donation after circulatory death, as well as the techniques of heart reconditioning after a period of warm ischaemia, is presented. The implementation of new techniques of donor heart preservation may contribute to the use of hearts from extended criteria donors, thereby expanding the total donor pool.
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Affiliation(s)
- Sarkis M Minasian
- Institute of Experimental Medicine, Federal Almazov Medical Research Centre, St Petersburg, Russian Federation Department of Pathophysiology, First Pavlov State Medical University of St Petersburg, St Petersburg, Russian Federation
| | - Michael M Galagudza
- Institute of Experimental Medicine, Federal Almazov Medical Research Centre, St Petersburg, Russian Federation Department of Pathophysiology, First Pavlov State Medical University of St Petersburg, St Petersburg, Russian Federation
| | - Yuri V Dmitriev
- Institute of Experimental Medicine, Federal Almazov Medical Research Centre, St Petersburg, Russian Federation
| | - Andrey A Karpov
- Institute of Experimental Medicine, Federal Almazov Medical Research Centre, St Petersburg, Russian Federation Department of Pathophysiology, First Pavlov State Medical University of St Petersburg, St Petersburg, Russian Federation
| | - Timur D Vlasov
- Institute of Experimental Medicine, Federal Almazov Medical Research Centre, St Petersburg, Russian Federation Department of Pathophysiology, First Pavlov State Medical University of St Petersburg, St Petersburg, Russian Federation
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Tevaearai Stahel HT, Unger D, Schmidli J, Gahl B, Englberger L, Kadner A, Eberle B, Mohacsi P, Carrel TP. Supplemental Cardioplegia Immediately before Graft Implantation may Improve Early Post-Transplantation Outcome. Front Surg 2014; 1:46. [PMID: 25593970 PMCID: PMC4286961 DOI: 10.3389/fsurg.2014.00046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 11/12/2014] [Indexed: 11/29/2022] Open
Abstract
Background: Preservation of cardiac grafts for transplantation is not standardized and most centers use a single administration of crystalloid solution at the time of harvesting. We investigated possible benefits of an additional dose of cardioplegia dispensed immediately before implantation. Methods: Consecutive adult cardiac transplantations (2005–2012) were reviewed. Hearts were harvested following a standard protocol (Celsior 2L, 4–8°C). In 2008, 100 ml crystalloid cardioplegic solution was added and administered immediately before implantation. Univariate and logistic regression analyses were used to investigate risk factors for post-operative graft failure and mid-term outcome. Results: A total of 81 patients, 44 standard (“Cardio−”) vs. 37 with additional cardioplegia (“Cardio+”) were analyzed. Recipients and donors were comparable in both groups. Cardio+ patients demonstrated a reduced need for defibrillation (24 vs. 48%, p = 0.03), post-operative ratio of CK-MB/CK (10.1 ± 3.9 vs. 13.3 ± 4.2%, p = 0.001), intubation time (2.0 ± 1.6 vs. 7.2 ± 11.5 days, p = 0.05), and ICU stay (3.9 ± 2.1 vs. 8.5 ± 7.8 days, p = 0.001). Actuarial survival was reduced when graft ischemic time was >180 min in Cardio− but not in Cardio+ patients (p = 0.033). Organ ischemic time >180 min (OR: 5.48, CI: 1.08–27.75), donor female gender (OR: 5.84, CI: 1.13–33.01), and recipient/donor age >60 (OR: 6.33, CI: 0.86–46.75), but not the additional cardioplegia or the observation period appeared independent predictors of post-operative acute graft failure. Conclusion: An additional dose of cardioplegia administered immediately before implantation may be a simple way to improve early and late outcome of cardiac transplantation, especially in situations of prolonged graft ischemia. A large, ideally multicentric, randomized study is desirable to verify this preliminary observation.
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Affiliation(s)
- Hendrik T Tevaearai Stahel
- Clinic for Cardiovascular Surgery, Bern University Hospital (Inselspital), University of Bern , Bern , Switzerland
| | - Darja Unger
- Clinic for Cardiovascular Surgery, Bern University Hospital (Inselspital), University of Bern , Bern , Switzerland
| | - Juerg Schmidli
- Clinic for Cardiovascular Surgery, Bern University Hospital (Inselspital), University of Bern , Bern , Switzerland
| | - Brigitta Gahl
- Clinic for Cardiovascular Surgery, Bern University Hospital (Inselspital), University of Bern , Bern , Switzerland
| | - Lars Englberger
- Clinic for Cardiovascular Surgery, Bern University Hospital (Inselspital), University of Bern , Bern , Switzerland
| | - Alexander Kadner
- Clinic for Cardiovascular Surgery, Bern University Hospital (Inselspital), University of Bern , Bern , Switzerland
| | - Balthasar Eberle
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital (Inselspital), University of Bern , Bern , Switzerland
| | - Paul Mohacsi
- Department of Cardiology, Bern University Hospital (Inselspital), University of Bern , Bern , Switzerland
| | - Thierry P Carrel
- Clinic for Cardiovascular Surgery, Bern University Hospital (Inselspital), University of Bern , Bern , Switzerland
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Myocardial Protection in Donor Heart Preservation: A Comparison Between Bretschneider's Histidine–Tryptophan–Ketoglutarate Solution and Cold Blood Cardioplegia. Transplant Proc 2014; 46:1077-81. [DOI: 10.1016/j.transproceed.2013.11.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 11/03/2013] [Accepted: 11/22/2013] [Indexed: 11/23/2022]
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