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Rivista di Chirurgia Cardiaca, Vascolare e Toracica

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The Journal of Cardiovascular Surgery 2000 June;41(3):363-70

lingua: Inglese

The effect of short-term coronary perfusion using oxygenated diluted blood following cold storage for long-term heart preservation

Hasegawa Y., Suzuki M., Ohtaki A., Takahashi T., Sato Y., Ishikawa S., Morishita Y.

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


Back­ground. The aim of ­this ­study was to com­pare the ­results ­obtained ­from the use of ­both Uni­ver­sity of Wis­consin (UW) solu­tion and ­diluted ­blood in ­short-­term cor­o­nary per­fu­sion fol­lowing 12-­hour ­cold ­storage.
­Methods. Fol­lowing cor­o­nary vas­cular ­washout of ­adult mon­grel ­dogs ­with the UW solu­tion, the ­heart was ­excised and ­immersed in a ­cold (4°C) UW solu­tion for 12 ­hours fol­lowed by 1-­hour of cor­o­nary per­fu­sion. Two dif­ferent solu­tions ­were ­used for the cor­o­nary per­fu­sion; a 4°C oxy­gen­ated UW solu­tion (­Group U, n=7) and 15°C oxy­gen­ated ­diluted ­blood (­Group B, n=7). Myo­car­dial ­high ­energy phos­phate (HEP) ­levels, ­tissue ­water con­tent (TWC), inter­sti­tial ­tissue ­space (ITS) ­rates and his­to­log­ical find­ings ­were eval­u­ated at 0- and 12-­hour ­cold ­storage and ­also fol­lowing cor­o­nary per­fu­sion. The pre­served ­graft was ­then eval­u­ated ­through ortho­topic trans­plan­ta­tion. The con­trol ­group in ­this experi­ment con­sisted of ­seven ­hearts trans­planted ­after 12-­hour ­cold ­storage ­without cor­o­nary per­fu­sion.
­Results. Myo­car­dial HEP ­levels sig­nif­i­cantly ­decreased ­after 12-­hour ­cold ­storage. The ­recovery ­rate of myo­car­dial HEP ­levels ­after cor­o­nary per­fu­sion was sig­nif­i­cantly (p<0.05) ­higher in ­Group B ­than in ­Group U. The ­increase of myo­car­dial TWC ­during cor­o­nary per­fu­sion was sig­nif­i­cantly (p<0.01) ­higher in ­Group B ­than in ­Group U. ­After 1-­hour cor­o­nary per­fu­sion, the sub­en­do­car­dial ITS ­rate was sig­nif­i­cantly (p<0.01) ­higher com­pared ­with the ­value at 0-­hour ­cold ­storage in ­Group U, ­whereas it dem­on­strated no sig­nif­i­cant ­change in ­Group B. PAS ­stain ­revealed the gly­cogen con­tent of the sub­en­do­car­dial tis­sues was ­higher in ­Group B ­than in ­Group U. The ­recovery ­rate of hemo­dy­namic param­e­ters 2 ­hours ­after ­heart trans­plan­ta­tion was ­higher in ­Group U and sig­nif­i­cantly (p<0.05) ­higher in ­Group B ­than in the con­trol.
Con­clu­sions. Myo­car­dial HEP ­levels recov­ered sig­nif­i­cantly ­after addi­tional cor­o­nary per­fu­sion. ­Though the UW solu­tion pre­vented myo­car­dial cel­lular ­edema, sub­en­do­car­dial per­fu­sion was incom­plete and the ­recovery ­rate of myo­car­dial HEP ­levels was ­lower, sug­gesting ­that ­diluted ­blood may ­become the solu­tion of ­choice as a per­fu­sate.

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