Heart Ablation Avoiding Asystolia with an Always- Beating Heart

Abstract

Purpose To avoid asystole during the ablation of the heart to improve the viability of the heart using the normothermic perfusion in Langendorff mode as a preservation method during ablation avoiding chemical cryopreservation. Methods Material: Five domestic young pigs (Landrace), each weighing 40 ± 10 kg, were used in this study. Surgical Procedure A midsternal thoracotomy was performed. We opened the pericardium and administered in the right atrium 300 IU of sodium heparin. The next step was to dissect the vessels of the neck and the descending aorta. After that, we performed the clamping and section of the descending aorta where we introduced a 6.5 endotracheal tube with balloon to the transverse aorta. Then we made a tourniquet in the right atrium and placed a cannula UCI 22 French. The perfusion of the heart started in Langendorff mode. The heart was perfused retrograde from the aorta into the coronary arteries. The next step was to cut the vessels in the neck and at the end we dissected the transverse aorta and the descending aorta. Finally, the inferior vena cava, the pulmonary artery and the pulmonary veins were ligated and sectioned. The heart was always beating and once the ablation of the heart was completed, it was placed inside a transfer box to the ex vivo perfusion platform. Normothermic Ex Vivo heart Perfusion In Langendorff-mode, the heart was perfused retrograde from the aorta into the coronary arteries. Coronary perfusion pressure was kept at 70 mmHg and the coronary flow was at 500-800 ml / min. The drainage of the blood from the coronary sinus was performed by a cannula UCI 22 French to a reservoir from which the pulsatile device took the blood and sent it to the oxygenator to then perfuse in a retrograde way by the cannula placed in the descending aorta with anticoagulated and oxygenated blood. Results Coronary perfusion pressure was kept at 70 mmHg and the coronary flow was at 500-800 ml / min. In no case, we registered ventricular fibrillation. Conclusion In all the ablations it was possible to avoid the asystole and the heart kept beating during the transfer to the ex vivo perfusion platform. In none of the cases, inotropic drugs were used.The ablation of the heart avoiding asystole is a simple and reproducible technique that reduces the damage caused by ischemia-reperfusion. The advantage of avoiding asystole is to maintain the viability of the myocardial cells while maintaining its metabolism in normothermia.