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      Development of a Vascularized Heterotopic Neonatal Rat Heart Transplantation Model

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          Background/Purpose: Rodent adult-to-adult heterotopic heart transplantation is a well-established animal model, and the detailed surgical technique with several modifications has been previously described. In immature donor organ transplantation, however, the surgical technique needs to be revised given the smaller size and fragility of the donor graft. Here, we report our surgical technique for heterotopic abdominal (AHTx) and femoral (FHTx) neonatal rat heart transplantation based on an experience of over 300 cases. Methods: Heterotopic heart transplantation was conducted in syngeneic Lewis rats. Neonatal rats (postnatal day 2-4) served as donors. AHTx was performed by utilizing the conventional adult-to-adult transplant method with specific modifications for optimal aortotomy and venous anastomosis. In the FHTx, the donor heart was vascularized by connecting the donor's aorta and pulmonary artery to the recipient's right femoral artery and vein, respectively, in an end-to-end manner. A specifically fashioned butterfly-shaped rubber sheet was used to align the target vessels properly. The transplanted graft was visually assessed for its viability and was accepted as a technical success when the viability met specific criteria. Successfully transplanted grafts were subject to further postoperative evaluation. Forty cases (AHTx and FHTx; n = 20 each) were compared regarding perioperative parameters and outcomes. Results: Both models were technically feasible (success rate: AHTx 75% vs. FHTx 70%) by refining the conventional heterotopic transplant technique. Injury to the fragile donor aorta and congestion of the graft due to suboptimal venous connection were predominant causes of failure, leading to refractory bleeding and poor graft viability. Although the FHTx required significantly longer operation time and graft ischemic time, the in situ graft viabilities were comparable. The FHTx provided better postoperative monitoring as it enabled daily graft palpation and better echocardiographic visualization. Conclusions: We describe detailed surgical techniques for AHTx and FHTx while addressing neonatal donor-specific issues. Following our recommendations potentially reduces the learning curve to achieve reliable and reproducible results with these challenging animal models.

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          Most cited references 19

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          Vessel formation. De novo formation of a distinct coronary vascular population in neonatal heart.

          The postnatal coronary vessels have been viewed as developing through expansion of vessels formed during the fetal period. Using genetic lineage tracing, we found that a substantial portion of postnatal coronary vessels arise de novo in the neonatal mouse heart, rather than expanding from preexisting embryonic vasculature. Our data show that lineage conversion of neonatal endocardial cells during trabecular compaction generates a distinct compartment of the coronary circulation located within the inner half of the ventricular wall. This lineage conversion occurs within a brief period after birth and provides an efficient means of rapidly augmenting the coronary vasculature. This mechanism of postnatal coronary vascular growth provides avenues for understanding and stimulating cardiovascular regeneration following injury and disease. Copyright © 2014, American Association for the Advancement of Science.
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            The technique for heterotopic cardiac transplantation in mice: experience of 3000 operations by one surgeon.

            The mouse heterotopic fully vascularized cardiac transplantation model has come into widespread use. However, the technique is still difficult. Therefore, simple anastomosis was introduced. The donor ascending aorta was sutured end-to-side to the recipient abdominal aorta and the donor pulmonary artery was anastomosed to the recipient inferior vena cava. The main point was only 4 stitches on 1 side between proximal and distal anastomosis of the recipient aorta and inferior vena cava. When beginners tried to perform the same procedure, they were able to complete the first successful procedure after 11 trials and achieved 90% success after 78 operations. The simple anastomosis is safe and shortens the operation time.
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              Endocardial fibroelastosis is caused by aberrant endothelial to mesenchymal transition.

              Endocardial fibroelastosis (EFE) is a unique form of fibrosis, which forms a de novo subendocardial tissue layer encapsulating the myocardium and stunting its growth, and which is typically associated with congenital heart diseases of heterogeneous origin, such as hypoplastic left heart syndrome. Relevance of EFE was only recently highlighted through the establishment of staged biventricular repair surgery in infant patients with hypoplastic left heart syndrome, where surgical removal of EFE tissue has resulted in improvement in the restrictive physiology leading to the growth of the left ventricle in parallel with somatic growth. However, pathomechanisms underlying EFE formation are still scarce, and specific therapeutic targets are not yet known.

                Author and article information

                Eur Surg Res
                European Surgical Research
                Eur Surg Res
                S. Karger AG (Basel, Switzerland karger@ )
                November 2016
                20 August 2016
                : 57
                : 3-4
                : 240-251
                Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass., USA
                ESR20160573-4240 Eur Surg Res 2016;57:240-251
                © 2016 S. Karger AG, Basel

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                Page count
                Figures: 4, Tables: 1, References: 21, Pages: 12
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