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Submandibular Gland-preserving Technique for Heterotopic Cervical Heart Transplantation in Mice

Fukunaga, Naoto, MD1; Bissoondath, Ved1; Rao, Vivek, MD, PhD1

doi: 10.1097/TP.0000000000002395
In Brief

1 Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.

Received 11 July 2018. Revision received 24 July 2018.

Accepted 25 July 2018.

The authors declare no funding or conflicts of interest.

All participated in research design. N.F. participated in performing surgery and the writing of the article. V.B. and V.R. were supervisors.

Correspondence: Vivek Rao, MD, PhD, Munk Chair in Advanced Cardiac Therapeutics, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada. (

Since the introduction of cuff technique,1 heterotopic cervical heart transplantation (HCHT) has been used although abdominal model is common.2 We report our submandibular gland-preserving technique for HCHT to avoid vessel twisting.

Animal care committee approved our research. In the recipient mouse, a skin incision was made over the right side of the neck from the sternum to the lower mandible. Under a microscope, the right external jugular vein was bluntly dissected. No manipulation of the right lobe of the submandibular gland was needed, but the subcutaneous part above the gland was dissected to mobilize the skin. After this, techniques of making the cuffs and implanting the heart were similar to those in the literature.3

We experienced three deaths out of 79 HCHTs because of twisting of both vessels. On inspection, the heart was displaced to the middle side of the neck and both the pulmonary artery and ascending aorta were twisted. It was because there was too much space associated with the removal of the right lobe of the submandibular gland.

As described above, the skin, now detached, is easily stretched over both the submandibular gland and donor heart. This snug fit seems to minimize the chance of heart malrotation (Figures 1A and B). Without the submandibular gland, the donor heart is easily displaced beyond the center of the body even if it is in the correct position before skin closure (Figures 1C and D).



Since the introduction of this technique, no case of vessel twisting (0/67 HCHTs) has occurred.

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1. Matsuura A, Abe T, Yasuura K. Simplified mouse cervical heart transplantation using a cuff technique. Transplantation. 1991;51:896–898.
2. Benke K, Sayour AA, Matyas C, et al. Heterotopic abdominal rat heart transplantation as a model to investigate volume dependency of myocardial remodeling. Transplantation. 2017;101:498–505.
3. Ratschiller T, Deutsch MA, Calzada-Wack J, et al. Heterotopic cervical heart transplantation in mice. J Vis Exp. 2015;102:e52907.
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