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Biomed Res Int. 2017;2017:4107587. doi: 10.1155/2017/4107587. Epub 2017 Mar 20.

Preservation of Myocardial Perfusion and Function by Keeping Hypertrophied Heart Empty and Beating for Valve Surgery: An In Vivo MR Study of Pig Hearts.

Wang J1,2,3, Xiang B2,4, Deng J2,3, Lin HY2, Freed DH2,3,5, Arora RC2,3,6, Tian G2,3.

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Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China.
National Research Council of Canada, 435 Ellice Avenue, Winnipeg, MB, Canada R3B 1Y6.
Department of Physiology, Faculty of Medicine, University of Manitoba, 727 McDermot Avenue, Winnipeg, MB, Canada R3E 3P5.
Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Manitoba, 753 McDermot Avenue, Winnipeg, MB, Canada R3E 0T6.
Division of Cardiac Surgery, University of Alberta Hospital, 8440-112 Street, Edmonton, AB, Canada T6G 2B7.
Cardiac Science Program, Institute of Cardiovascular Science, St. Boniface General Hospital, 409 Tache Avenue, Winnipeg, MB, Canada R2H 2A6.


Objectives. Normothermic hyperkalemic cardioplegia arrest (NHCA) may not effectively preserve hypertrophied myocardium during open-heart surgery. Normothermic normokalemic beating perfusion (NNBP), keeping hearts empty-beating, was utilized as an alternative to evaluate its cardioprotective role. Materials and Methods. Twelve hypertrophied pig hearts at 58.6 ± 7.2 days after ascending aorta banding underwent NNBP and NHCA, respectively. Near infrared myocardial perfusion imaging with indocyanine green (ICG) was conducted to assess myocardial perfusion. Left ventricular (LV) contractile function was assessed by cine MRI. TUNEL staining and western blotting for caspase-3 cleavage and cardiac troponin I (cTnI) degradation were conducted in LV tissue samples. Results. Ascending aortic diameter was reduced by 52.7% ± 0.4% at approximately fifty-eight days after banding. LV wall thickness was significantly higher in aorta banding than in sham operation. Myocardial blood flow reflected by maximum ICG absorbance value was markedly higher in NNBP than in NHCA. The amount of apoptotic cardiomyocyte was significantly lower in NNBP than in NHCA. NNBP alleviated caspase-3 cleavage and cTnI degradation associated with NHCA. NNBP displayed a substantially increased postoperative ejection fraction relative to NHCA. Conclusions. NNBP was better than NHCA in enhancing myocardial perfusion, inhibiting cardiomyocyte apoptosis, and preserving LV contractile function for hypertrophied hearts.

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