Reconnecting the vagus nerve to the heart through nerve conduit preserves cardiac function in a minipig model of right cardiac vagotomy

The right vagus nerve is essential for cardiac homeostasis, and its intrathoracic resection can lead to postoperative cardiac complications. Strategies to restore vagal innervation after transection at the cardiac level remain lacking. Here, we show that early reconnection of the right vagus nerve using an implantable chitosan/poly-ε-caprolactone cuff-like nerve guidance conduit preserved cardiac mechanical function in adult male minipigs subjected to right cardiac vagotomy. Treated animals displayed improved global circumferential, longitudinal, and radial strains and reduced diastolic dyssynchrony. Histological analysis revealed partial repair with about 20% viable vagal fascicles, restoration of myocardial parasympathetic fibers, normalization of oxidative stress and aging markers, and prevention of interstitial fibrosis. These findings suggest that maintaining even limited vagal input prevents early cardiac remodeling by mitigating oxidative stress-induced premature senescence of cardiac cells. Reconnection of the right vagus nerve with chitosan/poly-ε-caprolactone cuff-like nerve guidance conduit may represent a therapeutic approach to preventing right vagotomy-induced heart failure after thoracic surgery or cardiothoracic transplantation.