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The Journal of Thoracic and Cardiovascular Surgery, Vol 116, 821-830, Copyright © 1998 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
WH Hassanein, L Zellos, TA Tyrrell, NA Healey, MD Crittenden, V Birjiniuk and SF Khuri
OBJECTIVES: Improving methods of donor heart preservation may permit
prolonged storage and remote procurement of cardiac allografts. We
hypothesized that continuous, sanguineous perfusion of the donor heart in
the beating, working state may prolong myocardial preservation. METHODS: We
developed a portable perfusion apparatus for use in donor heart
preservation. Contractile, metabolic, and vasomotor functions were
monitored simultaneously in an isolated swine heart. The metabolic state
was monitored by myocardial tissue pH. Vasomotor function was assessed in
isolated coronary ring chambers. Hearts were randomized into 3 groups:
group I (n = 5), cardioplegic arrest, 12-hour storage at 4 degrees C with
modified Belzer solution, and 2-hour sanguineous reperfusion in the working
state; group II (n = 6), 12-hour continuous perfusion in the beating
working state, 30 minutes of arrest (to simulate re-implantation time), and
2 hours of reperfusion, as above; group III (n = 7), coronary ring control
hearts. RESULTS: At 2 hours of reperfusion, left ventricular developed
pressure in group II was higher than in group I (mean +/- standard
deviation: 90 +/- 6 mm Hg, 53 +/- 15 mm Hg, P = .005). Significantly less
myocardial edema was observed in group II than in group I (73% +/- 4%, 80%
+/- 1% water content, P = .01). Significantly less myocardial acidosis was
noted in group II than in group I during preservation (pH 7.3 +/- 0.01, 6.1
+/- 0.03, P < .001) and reperfusion (pH 7.3 +/- 0.008, 6.8 +/- 0.05, P
< .001). Coronary endothelial vasomotor function was better preserved in
group II than in group I as evidenced by dose-response relaxation of
coronary rings to 10(-8) mol/L bradykinin (37%, 55% delta baseline, P =
.01). CONCLUSION: This new method extends the current preservation limit
and avoids time-dependent ischemic injury, thereby allowing for distant
procurement of donor organs.
ARTICLES
Continuous perfusion of donor hearts in the beating state extends preservation time and improves recovery of function
Department of Surgery, Brockton/West Roxbury Veterans Administration Medical Center, Harvard Medical School, Boston, Mass 02132, USA.
This article has been cited by other articles:
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  M. J. Collins, S. L. Moainie, B. P. Griffith, and R. S. Poston Preserving and evaluating hearts with ex vivo machine perfusion: an avenue to improve early graft performance and expand the donor pool. Eur. J. Cardiothorac. Surg., August 1, 2008; 34(2): 318 - 325. [Abstract] [Full Text] [PDF]
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 B. P. Griffith, M. Haddad, and R. S. Poston Immunobiology of Heart and Heart-Lung Transplantation Card. Surg. Adult, January 1, 2008; 3(2008): 1513 - 1538. [Full Text]
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 R. S. Poston and B. P. Griffith Heart Transplantation J Intensive Care Med, January 1, 2004; 19(1): 3 - 12. [Abstract] [PDF]
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B. P. Griffith and R. S. Poston Immunobiology of Heart and Heart-Lung Transplantation Card. Surg. Adult, January 1, 2003; 2(2003): 1403 - 1426. [Full Text]
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 V. Rao, C. M. Feindel, G. Cohen, M. A. Borger, P. Boylen, and H. J. Ross Is profound hypothermia required for storage of cardiac allografts? J. Thorac. Cardiovasc. Surg., September 1, 2001; 122(3): 501 - 507. [Abstract] [Full Text] [PDF]
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