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Krishnan A, Guenthart BA, Ruaengsri C, Elde S, Zhu Y, MacArthur JW, Woo YJ. Beating Heart Transplantation: How to Do It. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2024; 19:88-91. [PMID: 38258625 DOI: 10.1177/15569845231220678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Heart transplantation utilizing deceased after circulatory death (DCD) donors has expanded the donor pool through the use of ex vivo normothermic perfusion. Compared with brain death donation, the conventional method of performing DCD heart transplantation includes an additional period of warm and cold ischemia. We have developed a beating heart implantation technique that obliviates the need for a second cardioplegic arrest and the associated reperfusion injury. We hypothesize this reproducible method may improve short-term and long-term outcomes to mirror results seen in brain death donors and provide details on how to perform beating heart transplantation.
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Affiliation(s)
- Aravind Krishnan
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA, USA
| | - Brandon A Guenthart
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA, USA
| | - Chawannuch Ruaengsri
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA, USA
| | - Stefan Elde
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA, USA
| | - Yuanjia Zhu
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA, USA
- Department of Bioengineering, Stanford University School of Engineering, CA, USA
| | - John Ward MacArthur
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA, USA
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA, USA
- Department of Bioengineering, Stanford University School of Engineering, CA, USA
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Kot TKM, Chan JSK, Froghi S, Lau DHH, Morgan K, Magni F, Harky A. Warm versus cold cardioplegia in cardiac surgery: A meta-analysis with trial sequential analysis. JTCVS OPEN 2021; 6:161-190. [PMID: 36003589 PMCID: PMC9390447 DOI: 10.1016/j.xjon.2021.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/17/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Thompson Ka Ming Kot
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
- Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Jeffrey Shi Kai Chan
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
| | - Saied Froghi
- Division of Surgery and Interventional Sciences, Royal Free Hospital, University College London, London, United Kingdom
| | - Dawnie Ho Hei Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
| | - Kara Morgan
- Department of Cardiology, Manchester Royal Infirmary, Manchester, United Kingdom
- Faculty of Biology, Medicine & Health, Division of Pharmacy & Optometry, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Francesco Magni
- Faculty of Medicine, University College London, London, United Kingdom
- Address for reprints: Francesco Magni, University College London Medical School, London, United Kingdom.
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
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Wu F, Wang W, Duan Y, Guo J, Li G, Ma T. Effect of Parecoxib Sodium on Myocardial Ischemia-Reperfusion Injury Rats. Med Sci Monit 2021; 27:e928205. [PMID: 33395402 PMCID: PMC7791896 DOI: 10.12659/msm.928205] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/19/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND We aimed to explore the effect of parecoxib sodium on myocardial ischemia-reperfusion (I/R) injury rats and its mechanism. MATERIAL AND METHODS The coronary artery of Sprague-Dawley rats was occluded for 6 h of myocardial ischemia, followed by reperfusion for 30 min (I/R group). Before ischemia, parecoxib sodium (10 mg/kg) was intraperitoneally injected twice a day for 3 consecutive days, followed by reperfusion for 6 h (I/R+Pare group). The cardiac function and changes in the infarction area were evaluated via echocardiography in each group. The differences in the expressions of apoptosis-related proteins were determined via immunohistochemistry and western blotting. Then, the percentage of reactive oxygen species (ROS)⁺ cells and the content of lipid peroxide were detected, based on which the degree of oxidative stress was evaluated. Next, the expressions of nuclear factor-kappaB (NF-kappaB) and nuclear factor E2-related factor 2 (Nrf-2) signaling pathways and downstream target genes were determined using real-time quantitative polymerase chain reaction (PCR). RESULTS After treatment with parecoxib sodium, the cardiac function of I/R injury rats was restored, and the infarction area and apoptosis level were reduced (P<0.05). Parecoxib sodium reduced the levels of ROS and lipid peroxidation in myocardial I/R injury rats, thereby weakening oxidative stress. It also regulated the redox imbalance caused by I/R injury through regulating NF-kappaB and Nrf-2 (P<0.01). In addition, after treatment with parecoxib sodium, NF-kappaB was significantly downregulated, while Nrf-2 was upregulated, and the content of proinflammatory cytokines was obviously reduced (P<0.01). CONCLUSIONS Parecoxib sodium exerts a protective effect against myocardial I/R injury through regulating antioxidant and inflammatory mechanisms.
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Affiliation(s)
- Fangyong Wu
- Department of Anesthesiology, Eastern Medical District of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, P.R. China
| | - Wei Wang
- Department of Anesthesiology, People’s Liberation Army (PLA) Rocket Force Characteristic Medical Center, Beijing, P.R. China
| | - Yingying Duan
- Department of Anesthesiology, Eastern Medical District of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, P.R. China
| | - Jia Guo
- Department of Anesthesiology, Eastern Medical District of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, P.R. China
| | - Guanhua Li
- Department of Anesthesiology, People’s Liberation Army (PLA) Rocket Force Characteristic Medical Center, Beijing, P.R. China
| | - Tao Ma
- Department of Anesthesiology, People’s Liberation Army (PLA) Rocket Force Characteristic Medical Center, Beijing, P.R. China
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Fouquet O, Dang Van S, Baudry A, Meisnerowski P, Robert P, Pinaud F, Binuani P, Chrétien JM, Henrion D, Baufreton C, Loufrani L. Cardiopulmonary bypass and internal thoracic artery: Can roller or centrifugal pumps change vascular reactivity of the graft? The IPITA study: A randomized controlled clinical trial. PLoS One 2020; 15:e0235604. [PMID: 32645079 PMCID: PMC7347139 DOI: 10.1371/journal.pone.0235604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 06/19/2020] [Indexed: 12/03/2022] Open
Abstract
Background Cardiopulmonary bypass (CPB) induces a systemic inflammatory response (SIRS) and affects the organ vascular bed. Experimentally, the lack of pulsatility alters myogenic tone of resistance arteries and increases the parietal inflammatory response. The purpose of this study was to compare the vascular reactivity of the internal thoracic arteries (ITAs) due to the inflammatory response between patients undergoing coronary artery bypass grafting (CABG) under CPB with a roller pump or with a centrifugal pump. Methods Eighty elective male patients undergoing CABG were selected using one or two internal thoracic arteries under CPB with a roller pump (RP group) or centrifugal pump (CFP group). ITA samples were collected before starting CPB (Time 1) and before the last coronary anastomosis during aortic cross clamping (Time 2). The primary endpoint was the endothelium-dependent relaxation of ITAs investigated using wire-myography. The secondary endpoint was the parietal inflammatory response of arteries defined by the measurements of superoxide levels, leukocytes and lymphocytes rate and gene expression of inflammatory proteins using. Terminal complement complex activation (SC5b-9) and neutrophil activation (elastase) analysis were performed on arterial blood at the same times. Results Exposure time of ITAs to the pump flow was respectively 43.3 minutes in the RP group and 45.7 minutes in the CFP group. Acetylcholine-dependent relaxation was conserved in the two groups whatever the time. Gene expression of C3 and C4a in the artery wall decreased from Time 1 to Time 2. No oxidative stress was observed in the graft. There was no difference between the groups concerning the leukocytes and lymphocytes rate. SC5b-9 and elastase increased between Time 1 and Time 2. Conclusion Endothelium-dependent relaxation of the internal thoracic arteries was preserved during CPB whatever the type of pump used. The inflammatory response observed in the blood was not found in the graft wall within this time frame. Trial registration Name of trial study protocol: IPITA Registration number (ClinicalTrials.gov): NCT04168853.
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Affiliation(s)
- Olivier Fouquet
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Angers, France
- MITOVASC Institute CNRS UMR 6214, INSERM U1083, University of Angers, Angers, France
- * E-mail:
| | - Simon Dang Van
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Angers, France
- MITOVASC Institute CNRS UMR 6214, INSERM U1083, University of Angers, Angers, France
| | - Anna Baudry
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Angers, France
- MITOVASC Institute CNRS UMR 6214, INSERM U1083, University of Angers, Angers, France
| | - Philippe Meisnerowski
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Angers, France
- MITOVASC Institute CNRS UMR 6214, INSERM U1083, University of Angers, Angers, France
| | - Pauline Robert
- MITOVASC Institute CNRS UMR 6214, INSERM U1083, University of Angers, Angers, France
| | - Frédéric Pinaud
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Angers, France
- MITOVASC Institute CNRS UMR 6214, INSERM U1083, University of Angers, Angers, France
| | - Patrice Binuani
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Angers, France
- MITOVASC Institute CNRS UMR 6214, INSERM U1083, University of Angers, Angers, France
| | | | - Daniel Henrion
- MITOVASC Institute CNRS UMR 6214, INSERM U1083, University of Angers, Angers, France
| | - Christophe Baufreton
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Angers, France
- MITOVASC Institute CNRS UMR 6214, INSERM U1083, University of Angers, Angers, France
| | - Laurent Loufrani
- MITOVASC Institute CNRS UMR 6214, INSERM U1083, University of Angers, Angers, France
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