Key result
A modified cardioprotection protocol including total body hypothermia, repeated cardioplegia, and aortic reclamping for persistent ventricular fibrillation facilitated recovery to stable sinus rhythm in sheep.
Why the study?
Heart valve implantation on the arrested sheep heart often causes significant on-table mortality due to difficulty restarting the heart, but successful cardioprotective management techniques in sheep are poorly defined.
Does a modified cardioprotection protocol improve survival and recovery to sinus rhythm in sheep undergoing surgical aortic valve replacement?
Observational (n=20)
No
Does a modified cardioprotection protocol improve survival and recovery to sinus rhythm in sheep undergoing surgical aortic valve replacement?
A modified cardioprotection protocol involving total body hypothermia, repeated cardioplegia, and reclamping the aorta for persistent ventricular fibrillation improves survival in a sheep model of aortic valve replacement.
Answers are grounded in this paper and cite their sources.
Supports testing of enhanced cardioprotection in large-animal cardiac surgery; leaves open translation to human aortic valve replacement.
Sheep are a commonly used and validated model for cardiovascular research and, more specifically, for heart valve research. Implanting a heart valve on the arrested heart in sheep is complex and is often complicated by difficulties in restarting the heart, causing significant on-table mortality. Therefore, optimal cardioprotective management during heart valve implantation in sheep is essential. However, little is known about successful cardioprotective management techniques in sheep. This article reports our experience in the cardioprotective management of 20 female sheep that underwent surgical aortic valve replacement with a stented tissue-engineered heart valve prosthesis. During this series of experiments, we modified our cardioprotection protocol to improve survival. We emphasize the importance of total body hypothermia and external cooling of the heart. Furthermore, we recommend repeated cardioplegia administration at 20 min intervals during surgery, with the final dosage of cardioplegia given immediately before the de-clamping of the aorta. To reduce the number of defibrillator shocks during a state of ventricular fibrillation (VF), we have learned to restart the heart by reclamping the aorta, administering cardioplegia until cardiac arrest, and de-clamping the aorta thereafter. Despite these encouraging results, more research is needed to finalize a protocol for this procedure.
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Vis et al. (2021) conducted an observational in Aortic valve replacement (animal model) (n=20). Modified cardioprotection protocol (hypothermia, repeated cardioplegia, aortic reclamping) was evaluated on Survival and recovery to spontaneous sinus rhythm. A modified cardioprotection protocol including total body hypothermia, repeated cardioplegia, and aortic reclamping for persistent ventricular fibrillation facilitated recovery to stable sinus rhythm in sheep.
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