Abstract
Background: Auxiliary cardiac support using heterotopic heart transplant is of considerable interest,
but the outcome is not known. To investigate technical feasibility and the possibility
of using auxiliary support from heterotopic heart transplantation without cardiopulmonary
bypass, we evaluated hemodynamics including the pressure–volume relationship in experimental
animals.
Methods
In heterotopic heart transplantation, we tailored the donor heart by removing the
pulmonary and tricuspid valves, and by wide removal of the inter-atrial septum. Next,
we anastomosed the descending aorta and left atrium of the donor heart to the descending
aorta and left atrium of the recipient, without using cardiopulmonary bypass. Consequently,
declamping the recipient’s descending aorta allowed the donor heart to fill with blood
and to start beating. We performed hemodynamic assessments including the effects of
adrenergic stimulation. We measured the pressure and volume relationship of the recipient
heart by closing and opening inflow of the donor left atrium to change the pre-load
of the donor left ventricle.
Results
The donor left ventricle produced a systolic blood pressure that was augmented by
the recipient blood pressure and responded to adrenergic stimulation. When inflow
of the donor left atrium was opened, the pressure–volume loop of the recipient heart
shifted to the left and pressure–volume area decreased. Simultaneously, the mechanical
efficiency and Emax (the slope of the end-systolic pressure-volume relationship) of the recipient heart
increased when inflow of the donor left atrium was opened.
Conclusions
This transplant model, without cardiopulmonary bypass, is feasible and can be applied
to transplant investigations as a working heart model on the basis of the response
of adrenergic stimulation. The increased pre-load of the donor left atrium from the
recipient left atrium resulted in a recipient leftward shift of the pressure–volume
relationship, suggesting that this transplant model with adequate pre-load acts as
auxiliary assistance in the recipient intrathoracic cavity.
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Article info
Publication history
Accepted:
November 6,
2000
Received:
January 10,
2000
Identification
Copyright
© 2001 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.
