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The Journal of Cardiovascular Surgery 1999 December;40(6):811-6

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

Effect of Celsior and University of Wisconsin solutions on myocardial metabolism and function after warm ischemia

Carrier M., Trudel S., Pelletier L. C.

From the Cardiovascolar Division Montreal Heart Institute, Montreal, Quebec, Canada


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Back­ground. ­Optimal pres­er­va­tion of ­donor ­hearts ­remains a sig­nif­i­cant con­cern ­during trans­plan­ta­tion. ­Organ ­shortage led to an ­increase in the use of dam­aged ­hearts.
­Methods. To ­study the ­effect of pres­er­va­tion solu­tions on ­recovery of myo­car­dial metab­olism and func­tion ­after ­warm ­ischemia, 10 ­dogs under­went 30 min­utes of ­warm ­global ­ischemia ­under car­di­o­pul­mo­nary ­bypass. The ani­mals ­were ­then admin­is­tered 1 ­liter of Cel­sior (5 ­dogs), an extra­cel­lular crys­tal­loid solu­tion or 1 ­liter of Uni­ver­sity of Wis­consin solu­tion (5 ­dogs), ­cooled at 4°C, fol­lowed by 60 min­utes of ­cold pres­er­va­tion and 30 min­utes of ­warm ­blood reper­fu­sion. Inter­sti­tial myo­car­dial pH and pO2 ­changes ­were meas­ured. The ­left ven­tricle dP/dt was meas­ured ­before and ­after the ­ischemic epi­sode, as ­where crea­tine ­kinase, tro­po­nine T and lac­tate ­serum ­levels.
­Results. ­Tissue pH aver­aged 6.9±0.1, 6.2±0.1, 6.7±0.1 and 6.8±0.1 ­before and ­after ­warm ­ischemia, fol­lowing the 60 min­utes of ­cold pres­er­va­tion and the reper­fu­sion ­period in ani­mals ­treated ­with the Cel­sior solu­tion, com­pared to 6.8±0.1, 6.4±0.1, 7±0.1 and 6.8±0.2 respec­tively in ­dogs ­treated ­with the Uni­ver­sity of Wis­consin solu­tion (p<0.05). ­Oxygen ten­sion in the myo­car­dium aver­aged 36±8 ­mmHg ­before ­warm ­ischemia and 59±31 ­mmHg ­after in ani­mals ­that ­received Cel­sior com­pared to 30±10 ­mmHg and 49±7 ­mmHg in ­dogs ­treated ­with Uni­ver­sity of Wis­consin (p>0.05). ­Global myo­car­dial func­tion ­decreased sig­nif­i­cantly fol­lowing reper­fu­sion com­pared to base­line in ­both ­groups of ani­mals. The ­serum ­levels of crea­tine ­kinase, tro­po­nine T and lac­tate ­increased sig­nif­i­cantly ­during the experi­ment ­although ­there was no sig­nif­i­cant dif­fer­ence ­between the 2 ­groups.
Con­clu­sion. ­Both pres­er­va­tion solu­tions (Cel­sior and Uni­ver­sity of Wis­consin) ­resulted in sub­op­timal ­recovery of myo­car­dial func­tion and metab­olism ­when admin­is­tered ­after a ­period of ­warm ­ischemia. Strat­e­gies to ­improve ­recovery of dam­aged ­donor ­hearts ­remain to be appro­pri­ately ­defined.

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