TY - CHAP
T1 - Vagal and sympathetic reinnervation after cardiac transplantation
T2 - Effect of type of surgery on baroreflex modulation of cardiovascular variability
AU - Bernardi, Luciano
AU - Passino, Claudio
AU - Spadacini, Giammario
AU - Valenti, Cinzia
AU - Rinaldi, Mauro
AU - Martinelli, Luigi
AU - Vigano, Mario
AU - Finardi, Giorgio
PY - 1999
Y1 - 1999
N2 - The human transplanted heart is a model of denervated heart, hence any fluctuation present in thc RR interval variability can be either due to reaquired innervation, or to represent the effect of some non autonomic activity, such as a direct effect of respiration on atrial stretch. Various physical and pharmacological manoeuvres on the respiratory and non-respiratory components of heart rate variability are used to assess the occurrence of reinnervation. So far reinnervation was limited to the sympathetic branch. This could be due to the 'standard' type of surgery that Ieaves most of vagal fibers intact. Our first observation of vagal reinnervation assessed by sinusoidal modulation of arterial baroreceptors by neck suction was obtained in a transplant patient (TX) who underwent a new type of surgery called 'bi-caval', characterised by a more extensive removal of the recipient atria. In a further study in 'bi-caval' TX the probability of observing vagal reinnervation was similar to that of sympathetic reinnervation; in contrast, this probability with the 'standard' technique is very low or zero regardless of time since transplantation, unless more extensive cutting of the recipient atria is performed. Similar to sympathetic reinnervation, vagal reinnervation progresses over time. In conclusion, there is the possibility to increase vagal reinnervation in patients undergoing heart transplantation, namely by extensive resection of ihe recipient atria. This observation has high clinical relevance because a better control of the cardiovascular system would improve adaptation to various stimuli and to physical exercise.
AB - The human transplanted heart is a model of denervated heart, hence any fluctuation present in thc RR interval variability can be either due to reaquired innervation, or to represent the effect of some non autonomic activity, such as a direct effect of respiration on atrial stretch. Various physical and pharmacological manoeuvres on the respiratory and non-respiratory components of heart rate variability are used to assess the occurrence of reinnervation. So far reinnervation was limited to the sympathetic branch. This could be due to the 'standard' type of surgery that Ieaves most of vagal fibers intact. Our first observation of vagal reinnervation assessed by sinusoidal modulation of arterial baroreceptors by neck suction was obtained in a transplant patient (TX) who underwent a new type of surgery called 'bi-caval', characterised by a more extensive removal of the recipient atria. In a further study in 'bi-caval' TX the probability of observing vagal reinnervation was similar to that of sympathetic reinnervation; in contrast, this probability with the 'standard' technique is very low or zero regardless of time since transplantation, unless more extensive cutting of the recipient atria is performed. Similar to sympathetic reinnervation, vagal reinnervation progresses over time. In conclusion, there is the possibility to increase vagal reinnervation in patients undergoing heart transplantation, namely by extensive resection of ihe recipient atria. This observation has high clinical relevance because a better control of the cardiovascular system would improve adaptation to various stimuli and to physical exercise.
UR - http://www.scopus.com/inward/record.url?scp=84887071029&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84887071029&partnerID=8YFLogxK
U2 - 10.3233/978-1-60750-904-2-177
DO - 10.3233/978-1-60750-904-2-177
M3 - Chapter
AN - SCOPUS:84887071029
VL - 60
SP - 177
EP - 188
BT - Studies in Health Technology and Informatics
ER -