ORIGINAL ARTICLES  CARDIAC PAPERS 

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

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

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.