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The Journal of Cardiovascular Surgery 1998 February;39(1):47-55

lingua: Inglese

The ­effects of ­the hypo­ther­mic man­age­ment of ­brain ­dead ­dogs on pre­serv­ing ­graft viabil­ity in ­heart trans­plan­ta­tion

Ichikawa H., Sakata K., Takahashi T., Ogiwara H., Otaki A., Ishikawa S., Morishita Y.

From ­the Second Department of Surgery, Gunma University School of Medicine, Maebashi, Japan


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The ­effect of hypo­ther­mic man­age­ment ­for ­brain ­dead ­dogs on pre­serv­ing ­graft viabil­ity ­was eval­u­at­ed ­through pres­er­va­tion ­and trans­plan­ta­tion. After ­the occur­rence of ­brain ­death, 43 ­dogs ­were divid­ed ­into ­two ­groups; ­the nor­mo­ther­mic ­group (37.2±0.3°C) ­and ­the hypo­ther­mic ­group (31.8±0.3°C) accord­ing to ­the esoph­a­geal tem­per­a­ture. After ­the 6-­hour man­age­ment of ­brain ­dead ­donors, ­the ­heart ­beat ­was arrest­ed ­using a car­di­o­pleg­ic solu­tion fol­lowed by cor­o­nary vas­cu­lar ­bed wash­out. The ­donor ­heart ­was ­then har­vest­ed ­and pre­served ­for 12 ­hours ­with sim­ple immer­sion ­into ­the University of Wisconsin solu­tion. Following pres­er­va­tion, ortho­top­ic trans­plan­ta­tion ­was per­formed in ­six ­grafts ran­dom­ly select­ed ­from ­each ­group. During ­the 6-­hour man­age­ment of ­brain ­dead ­dogs; l)­heart ­rates, ­rate-pres­sure prod­ucts, ­and ­the ­total ­amount of cat­e­chol­a­mine ­were sig­nif­i­cant­ly (p<0.05) low­er in ­the hypo­ther­mic ­group ­than in ­the nor­mo­ther­mic ­group, ­and 2) lactate con­tents col­lect­ed ­from ­the cor­o­nary ­sinus ­blood ­and O2-extrac­tion ­rates of ­the ­heart tend­ed to be low­er in ­the hypo­ther­mic ­group ­than in ­the nor­mo­ther­mic ­group. During 12 ­hours of pres­er­va­tion, intra­cel­lu­lar pH ­and crea­tine phos­phate con­tents ­were high­er in ­the hypo­ther­mic ­group ­than in ­the nor­mo­ther­mic ­group. Following ortho­top­ic trans­plan­ta­tion, ­the ani­mals in ­the hypo­ther­mic ­group ­showed a sig­nif­i­cant­ly (p<0.05) high­er recov­ery ­rate of ­left ven­tric­u­lar (LV) pres­sure ­and ­the max­i­mum ­rate of ­the ­rise of LV pres­sure com­pared ­with nor­mo­ther­mic ­group ani­mals. We con­clude ­that ­the hypo­ther­mic man­age­ment of ­brain ­dead ­dogs ­may be effec­tive in pre­serv­ing ­graft viabil­ity ­and ­may pro­vide a clin­i­cal appli­ca­tion ­for ­heart trans­plan­ta­tion ­with accept­able out­comes.

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