Related Experiment Videos
Effects of cardiac denervation on coronary and systemic circulation
J Amano1, A Suzuki, M Sunamori
1Department of Cardiothoracic Surgery, Tokyo Medical and Dental University, Japan.
Insights
Cardiac denervation combined with bypass grafting improved systemic hemodynamics and coronary circulation. This surgical approach reduced vascular resistance and enhanced blood flow in patients with occluded coronary arteries.
Area of Science:
- Cardiovascular Surgery
- Cardiac Physiology
- Hemodynamics
Background:
- Coronary artery bypass grafting (CABG) is a standard treatment for severe coronary artery disease.
- The role of cardiac autonomic nerves in modulating coronary circulation and systemic hemodynamics post-CABG is not fully understood.
- Cardiac denervation aims to alter autonomic control of the heart and vasculature.
Purpose of the Study:
- To investigate the effects of cardiac denervation on coronary circulation and systemic hemodynamics in patients undergoing CABG for a totally occluded left anterior descending artery.
- To compare outcomes between patients who received combined bypass grafting and denervation versus those who had bypass grafting alone.
Main Methods:
- A comparative study involving two groups of patients: Group I (n=14) underwent bypass grafting and intrapericardial denervation; Group II (n=19) underwent bypass grafting only.
- Hemodynamic parameters including heart rate, cardiac index, systemic vascular resistance index, and end-diastolic coronary resistance were measured.
- Plasma norepinephrine concentrations were assessed post-procedure.
Main Results:
- Group I showed a significantly lower systemic vascular resistance index (1,358 vs. 1,713 dynes.s.cm-5.m2, p < 0.02) and end-diastolic coronary resistance (0.59 vs. 1.04 mm Hg.mL-1.min-1, p < 0.05) compared to Group II.
- The end-diastolic graft flow/mean graft flow ratio was higher in Group I (1.56 vs. 1.28, p < 0.01).
- Plasma norepinephrine levels were significantly lower in Group I (223 vs. 328 pg/mL, p < 0.05) after denervation.
Conclusions:
- Cardiac denervation, when combined with bypass grafting, appears to favorably influence systemic hemodynamics.
- The procedure may enhance coronary circulation by reducing vascular resistance and improving graft flow.
- These findings suggest a potential beneficial role for cardiac denervation in specific patient populations undergoing CABG.
Abstract:
The effects of cardiac denervation on coronary circulation and systemic hemodynamics were examined in patients who underwent coronary artery bypass grafting for a totally occluded left anterior descending coronary artery. The results in 14 patients who had undergone a combination of bypass grafting and intrapericardial denervation (group I) were compared with those in 19 patients who had undergone only bypass grafting (group II). The heart rate was 110 +/- 4.9 beats/min in group I and 104 +/- 3.7 beats/min in group II after denervation. Although the cardiac index was not significantly different between the two groups, the calculated systemic vascular resistance index of group I (1,358 +/- 111 dynes.s.cm-5.m2) was significantly lower (p < 0.02) than that in group II (1,713 +/- 75 dynes.s.cm-5.m2). The end-diastolic coronary resistance was significantly lower (p < 0.05) in group I (0.59 +/- 0.05 mm Hg.mL-1.min-1) than that in group II (1.04 +/- 0.14 mm Hg.mL-1.min-1), and the end-diastolic graft flow/mean graft flow ratio was 1.56 +/- 0.05 in group I and 1.28 +/- 0.04 in group II (p < 0.01). The plasma norepinephrine concentration in group I (223 +/- 52 pg/mL) was significantly low (p < 0.05) compared with that in group II (328 +/- 39 pg/mL) after denervation. Thus, cardiac denervation may have a beneficial effect on systemic hemodynamics and coronary circulation.