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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 June;39(3):313-20

lingua: Inglese

A com­par­ison of the Uni­ver­sity of Wis­consin solu­tion and the mod­i­fied Kaw­a­kami solu­tion for ­initial ­flush and cor­o­nary per­fu­sion in ­long-­term ­canine ­heart pres­er­va­tion

Ogiwara H., Ichikawa H., Takahashi T., Ohtaki A., Ishikawa S., Morishita Y.

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


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Back­ground. We com­pared two dif­ferent solu­tions, the Uni­ver­sity of Wis­consin (UW) solu­tion (intra­cel­lular-­like) and the mod­i­fied Kaw­a­kami (mK) solu­tion (extra­cel­lular-­like), for ­initial ­flush of cor­o­nary vas­cular ­beds ­before ­simple ­storage and fol­lowing cor­o­nary per­fu­sion.
­Methods. ­After a ­right thor­a­co­tomy in the 4th inter­costal ­space, the ­donor ­heart was iso­lated by ­ligating the ­azygos ­vein and ­venae ­cavae, and ­cross-­clamping the ­aorta. Car­diac ­arrest was ­then ­obtained ­with a ­cold GIK solu­tion. Fol­lowing ­initial ­flush of cor­o­nary vas­cular ­beds, the ­donor ­heart was ­resected, ­stored uti­lizing a com­bi­na­tion of ­simple immer­sion and cor­o­nary per­fu­sion, and ­then trans­plan­ted. A ­total of 48 mon­grel ­dogs was ­divided ­into ­three ­groups ­each ­using dif­ferent solu­tions for the ­initial ­flush of cor­o­nary vas­cular ­beds and for cor­o­nary per­fu­sion. In ­group I (n=10) the UW solu­tion was ­used for ­both ­initial ­flush and cor­o­nary per­fu­sion. In ­group II (n=7) the mK solu­tion was ­used for ­both ­initial ­flush and cor­o­nary per­fu­sion, and in ­group III (n=7) the UW solu­tion was ­used for ­initial ­flush and the mK solu­tion for cor­o­nary per­fu­sion.
Intra­cel­lular ­high-­energy phos­phate was sur­veyed by 31P-­nuclear mag­netic res­o­nance spec­tros­copy.
­Results. ­After 12-­hour ­simple immer­sion and 1-­hour cor­o­nary per­fu­sion, phos­pho­crea­tine and aden­o­sine tri­phos­phate ­were sig­nif­i­cantly (p<0.05) ­higher in ­group III ­than in ­groups I and II. The ­high-­energy phos­phate ­levels of the ­graft ­tissue ­were ­better in ­groups I and III ­than in ­group II. Ortho­topic trans­plan­ta­tion was ­then per­formed ­using 10 pre­served ­grafts in ­group I and ­seven pre­served ­grafts of ­group III. ­After trans­plan­ta­tion, ­left ven­tric­ular (LV) pres­sure of ­group I ani­mals recov­ered to 82.3% and ­group III recov­ered to 95.8% of the con­trol ­values. LV dp/dt of ­group I and III ani­mals recov­ered to 76.5% and 96.7% of the con­trol ­values, respec­tively.
Con­clu­sions. The UW solu­tion, ­which is accept­able for ­both ­initial ­flush and ­simple ­storage, is not suit­able for con­tin­uous cor­o­nary per­fu­sion ­even for a ­short ­period due to its ­high vis­cosity. A com­bi­na­tion of the UW solu­tion ­both for ­initial ­flush and the fol­lowing ­cold ­simple immer­sion and the mK solu­tion for con­tin­uous cor­o­nary per­fu­sion is appro­priate for ­long-­term pres­er­va­tion of the ­canine ­heart.

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