title: Influence of type of surgery on the occurrence of parasympathetic reinnervation after cardiac transplantation.
abstract: BACKGROUND
  Cardiac autonomic reinnervation after human cardiac transplantation has been demonstrated frequently but to date only for sympathetic efferents. Standard surgical techniques leave many parasympathetic branches intact in the original atria and thus with less stimulus to reinnervate the donor atria.
  
  
  RESULTS
  We used changes in the RR-interval power spectrum induced by sinusoidal modulation of arterial baroreceptors by neck suction at different frequencies to detect both parasympathetic and sympathetic reinnervation in 79 subjects with "standard" and 10 "bicaval" heart transplants. In 24 subjects (17 standard and 7 bicaval), the protocol was repeated 6 and 11 months after transplantation. Neck suction at 0.20 Hz produced a component at 0.20 Hz in the RR-interval spectrum not due to respiration (fixed at 0.25 Hz), which suggested parasympathetic reinnervation, in 4 of 10 bicaval but in only 2 of 79 standard transplant subjects (whose recipient atria underwent >50% resection to remove scars of previous interventions), P<.001. In only 1 (bicaval) transplant subject was parasympathetic reinnervation present 6 months after transplantation (confirmed 3 months later); in 4 subjects, it was absent at 6 months but appeared after 11 months after transplantation. Atropine (0.04 mg/kg i.v.) abolished the response to fast (0.20 Hz) and reduced that to slow stimulation, confirming the presence of parasympathetic reinnervation (4 subjects).
  
  
  CONCLUSIONS
  Parasympathetic reinnervation depends on the surgical technique: because bicaval surgery cuts all sympathetic and parasympathetic nerves, regeneration might be stimulated similarly in both branches. Standard surgery cuts only approximately 50% of sympathetic fibers; most recipient parasympathetic axons remain intact, hence their regeneration might not be stimulated.
authors.affiliation: Department of Internal Medicine, University of Pavia and IRCCS S Matteo, Italy. LBern1ps@ipv36.unipv.it
authors.forename: L
authors.initials: L
authors.lastname: Bernardi
authors.forename: C
authors.initials: C
authors.lastname: Valenti
authors.forename: J
authors.initials: J
authors.lastname: Wdowczyck-Szulc
authors.forename: A W
authors.initials: AW
authors.lastname: Frey
authors.forename: M
authors.initials: M
authors.lastname: Rinaldi
authors.forename: G
authors.initials: G
authors.lastname: Spadacini
authors.forename: C
authors.initials: C
authors.lastname: Passino
authors.forename: L
authors.initials: L
authors.lastname: Martinelli
authors.forename: M
authors.initials: M
authors.lastname: Viganò
authors.forename: G
authors.initials: G
authors.lastname: Finardi
mesh_terms: D001285:Atropine; D016022:Case-Control Studies; D005500:Follow-Up Studies; D006321:Heart / Q000294:innervation*; D016027:Heart Transplantation / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D009416:Nerve Regeneration / Q000502:physiology*; D010275:Parasympathetic Nervous System / Q000502:physiology*; D010276:Parasympatholytics; D013564:Sympathetic Nervous System / Q000502:physiology*; D014684:Venae Cavae / Q000601:surgery
chemical_list: D010276:Parasympatholytics; D001285:Atropine