Trabecular cutting: A novel surgical therapy to increase diastolic compliance

Meagan Oglesby, Danny Escobedo, Gladys Patricia Escobar, Fatemeh Fatemifar, Edward Y. Sako, Steven R. Bailey, Hai Chao Han, Marc D. Feldman

Research output: Contribution to journalArticle

Abstract

Heart failure with preserved ejection fraction (HFpEF) is a common cause of hospital admission in patients over 65 yr old and has high mortality. HFpEF is characterized by left ventricular (LV) hypertrophy that reduces compliance. Current HFpEF therapies control symptoms, but no existing medications or therapies can sustainably increase LV compliance. LV trabeculae develop hypertrophy and fibrosis that contribute to reduced LV compliance. This study expands our previous results in ex vivo human hearts to show that severing LV trabeculae increases diastolic compliance in an ex vivo working rabbit heart model. Trabecular cutting was performed in ex vivo rabbit hearts set up in a working heart perfusion system perfused with oxygenated Krebs-Henseleit buffer. A hook was inserted in the LV to cut trabeculae. End-systolic and end-diastolic pressure-volume relationships during transient preload reduction were recorded using an admittance catheter in the following three groups: control (no cutting; n 9), mild cutting (15 cuts; n 5), and aggressive cutting (30 cuts; n 5). In a second experiment, each heart served as its own control. Hemodynamic data were recorded before and after trabecular cutting (n 10) or sham cutting (n 5) within the same heart. In the first experiments, trabecular cutting did not affect systolic function (P 0.05) but significantly increased overall diastolic compliance (P 0.009). Greater compliance was seen as trabecular cutting increased (P 0.002, r2 0.435). In the second experiment, significant increases in systolic function (P 0.048) and diastolic compliance (P 0.002) were seen after trabecular cutting compared with baseline. In conclusion, trabecular cutting significantly increases diastolic compliance without reducing systolic function.

Original languageEnglish (US)
Pages (from-to)457-463
Number of pages7
JournalJournal of applied physiology
Volume127
Issue number2
DOIs
StatePublished - 2019

Keywords

  • Diastolic function
  • Heart failure preserved ejection fraction
  • Heart surgery
  • Left ventricular relaxation

ASJC Scopus subject areas

  • Physiology
  • Physiology (medical)

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