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Alternate antegrade/retrograde perfusion: an effective technique to preserve hypertrophied hearts during valvular surgery

^a Institute for Biodiagnostics, National Research Council, 435 Ellice Avenue, Winnipeg, Manitoba, Canada
^b Department of Cardiovascular Surgery, the First Affiliated Hospital, Harbin Medical University, Harbin 150001, People's Republic of China
^c Division of Cardiothoracic Surgery, Jackson Memorial Hospital, Miller School of Medicine, University of Miami, Miami, FL, USA
^d Cardiac Sciences Program, St. Boniface General Hospital, University of Manitoba, Winnipeg, Canada

Received 15 April 2008; received in revised form 9 September 2008; accepted 9 October 2008.

^_* Corresponding author. Tel.: +1 204 984 6654; fax: +1 204 984 6978. (Email: Hongyuliu1963{at}hotmail.com; Hong.Tian{at}nrc-cnrc.gc.ca).
^_** Corresponding author. Tel.: +86 451 55685869; fax: +86 451 95554367. (Email: Hongyuliu1963{at}hotmail.com; Hong.Tian{at}nrc-cnrc.gc.ca).

Objective: Continuous antegrade perfusion (AP) may interfere with surgical precision. Continuous retrograde perfusion (RP), on the other hand, cannot sustain the empty-beating hypertrophied hearts. Therefore, alternate antegrade/retrograde perfusion (A_A/RP) may be a rational technique to preserve the hypertrophied hearts. This study is to determine whether A_A/RP could maintain myocardial energy metabolism, oxygenation, and contractile function of the empty-beating hypertrophied hearts. Methods: Sixteen hypertrophied pig hearts were divided into four groups (n = 4 per group). Group I and II underwent an 80-min A_A/RP (four 10-min APs and four 10-min RPs), followed by a 20-min reperfusion. Group III and IV were subjected to an 80-min AP and 20-min reperfusion and used as a control. Energy metabolism was evaluated in group I and III using magnetic resonance spectroscopy. Myocardial oxygenation (MO) was assessed in group II and IV using near infrared spectroscopic imaging. Results: During 80-min A_A/RP, four episodes of RP resulted in a significant decrease in myocardial phosphocreatine (PCr) and MO. The subsequent AP, however, resulted in complete recovery of the parameters. Moreover, myocardial adenosine triphosphate (ATP) remained at a normal level throughout the 80-min A_A/RP. As expected, hearts in groups III and IV showed normal level of myocardial PCr, ATP, and MO throughout protocol. Finally, hearts in all four groups showed similar contractile function during reperfusion. Conclusions: A_A/RP with four 10-min intervals of AP and RP sustained normal myocardial energy metabolism, oxygenation, and contractile function of empty-beating hypertrophied hearts. We conclude that A_A/RP is an effective technique for preservation of empty-beating hypertrophied hearts during valvular surgery.

Key Words: Hypertrophied heart • Antegrade perfusion • Retrograde perfusion • Empty-beating • Energy metabolism • Myocardial oxygenation