The Journal of Thoracic and Cardiovascular Surgery, Vol 100, 687-697, Copyright © 1990 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Extended ex vivo preservation of the heart and lungs. Effects of acellular oxygen-carrying perfusates and indomethacin on the autoperfused working heart-lung preparation
E Kaplan, JT Diehl, MB Peterson, KH Somerville, BD Daly, RJ Connolly, AG Cooper, SD Seiler and RJ Cleveland
Department of Surgery, Tufts University School of Medicine, Boston, Mass.
The autoperfused working heart-lung preparation has been proposed as a
method for long-term heart-lung preservation. We investigated the effects
of acellular oxygen-carrying perfusates (study 1) and the effect of donor
pretreatment with indomethacin (study 2) on the working ex vivo heart-lung
block. In study 1 perfusion with stroma-fee hemoglobin resulted in
significantly reduced survival (118 +/- 46 minutes) compared with
autologous blood (561 +/- 125 minutes, p less than 0.05) or perfluorocarbon
(438 +/- 114 minutes, p less than 0.05). Decrease in survival with
stroma-free hemoglobin perfusate is associated with a marked decrease in
left ventricular performance and a significant increase in pulmonary
vascular resistance. Perfusion with autologous blood is associated with a
significant increase in pulmonary vascular resistance after 240 minutes of
explantation, which is significantly delayed by perfusion with
perfluorocarbon. Perfusion for 6 hours with blood pretreated with
indomethacin (study 2) resulted in a decrease in the concentration of
prostacyclin and thromboxane A2 metabolites but an increase in the
prostaglandin/thromboxane A2 metabolite ratio. This is associated with
abrogation of the increase in pulmonary vascular resistance (12,787 +/-
1682 dynes/sec/cm-5, T = 0; 13,134 +/- 2654 dynes/sec/cm-5, T = 360
minutes) observed in preparations perfused with autologous blood (13,194
+/- 1942 dynes/sec/cm-5, T = 0; 24,768 +/- 3325 dynes/sec/cm-5, T = 360
minutes, p less than 0.05). We conclude that alteration of the cellular and
humoral components of autologous blood may prove advantageous for
increasing the utility of the autoperfused working heart-lung preparation
as a preservation technique.
