ORIGINAL ARTICLES  CARDIAC PAPERS 

The Journal of Cardiovascular Surgery 1998 June;39(3):313-20

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

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

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.