| Left ventricular pressure measurement by telemetry is an effective means to evaluate transplanted heart function in experimental heterotopic cardiac xenotransplantation. | |
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MedLine Citation:
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PMID: 20692431 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Evaluation of the function of heterotopic cardiac transplants has traditionally been accomplished by either manual palpation or serial biopsies. Both methods have drawbacks. Palpation can be difficult to differentiate a pulse from the graft versus a transmitted pulse from the native aorta. Serial biopsies, though accurate, require multiple laparotomies, leading to increased morbidity and possibly mortality rates. In this study we used an advanced telemetry system, consisting of an intra-abdominal implant, that was capable of continuously monitoring simultaneously several parameters of the transplanted heart and the status of the recipient. In a large animal model of heterotopic cardiac xenotransplantation (pig donor to baboon recipient), we implanted the device in 12 animals: 8 with and 4 without immunosuppression. We monitored and continuously recorded the left ventricular pressure (both peak-systolic and end-diastolic [LVEDP]), heart rate, and the electrocardiogram pattern of the transplanted heart as well as the temperature of the recipient. The left ventricular pressure proved to be the most valuable parameter to assess graft heart function. In the 4 nonimmunosuppressed cases, grafts were rejected acutely. In these cases, the end-diastolic pressure increased sharply and the heart stopped contracting when the difference between the systolic and the diastolic pressure decreased to <10 mm Hg. The earliest reproducible sign of rejection was an increased LVEDP. Among long-term survivors, the increase in diastolic pressure was gradual, indicating progressive thickening of the myocardium and decreased compliance of the ventricle. Six of 8 immunosuppressed animals died of other complications before rejecting the transplanted heart. The telemetry was also helpful to indicate early onset of fever in the recipients, thus allowing us to intervene early and prevent potentially lethal septic complications. Continuous monitoring of several parameters via telemetry allowed detection of changes associated with rejection as well as other complications at an early stage, allowing prompt intervention, treatment, and possibly reversal of rejection. |
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Authors:
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K A Horvath; P C Corcoran; A K Singh; R F Hoyt; C Carrier; M L Thomas; M M Mohiuddin |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Transplantation proceedings Volume: 42 ISSN: 1873-2623 ISO Abbreviation: Transplant. Proc. Publication Date: 2010 Jul-Aug |
Date Detail:
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Created Date: 2010-08-09 Completed Date: 2011-01-14 Revised Date: 2012-03-08 |
Medline Journal Info:
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Nlm Unique ID: 0243532 Medline TA: Transplant Proc Country: United States |
Other Details:
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Languages: eng Pagination: 2152-5 Citation Subset: IM |
Copyright Information:
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Copyright 2010 Elsevier Inc. All rights reserved. |
Affiliation:
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Cardiothoracic Surgery Research Program, National Heart, Lung, and Blood Institute, Bethesda, Maryland 20892, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Anastomosis, Surgical
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methods Animals Graft Rejection / immunology, pathology Graft Survival / immunology Heart Transplantation / adverse effects*, immunology Immunosuppressive Agents / therapeutic use Papio Survivors Swine Telemetry / methods* Tissue Donors Transplantation, Heterologous / adverse effects* |
| Grant Support | |
ID/Acronym/Agency:
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Z99 HL999999/HL/NHLBI NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Immunosuppressive Agents |
| Comments/Corrections | |
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