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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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

Copyright © 2000 EDIZIONI MINERVA MEDICA

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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