The Journal of Thoracic and Cardiovascular Surgery, Vol 96, 44-53, Copyright © 1988 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Long-term neonatal heart preservation
HG Davtyan, AF Corno, H Laks, S Bhuta, WM Flynn, C Laidig, P Chang and D Drinkwater
Department of Cardiothoracic Surgery, UCLA Medical Center 90024.
Donor availability is a major limiting factor in neonatal heart
transplantation. Prolonging donor heart preservation would facilitate
distant heart procurement. Forty-two neonatal (1 to 5 days) piglet hearts
in seven groups were arrested with cold cardioplegic solutions, stored for
12 hours at 4 degrees C in storage solutions, and reperfused with blood
from an adult support pig. The cardioplegic solutions used were a
crystalloid solution with potassium chloride 30 mEq/L and bicarbonate
(Stanford), the Stanford cardioplegic solution with the addition of calcium
(1.2 mmol/L), or an intracellular solution (Sacks) with added glucose.
Storage solutions were normal saline, Sacks II, or Sacks II with glucose 20
gm/L. Reperfusion was done with normal blood or modified blood for 20
minutes with superoxide dismutase, catalase, aspartate, glutamate,
citrate-phosphate-dextrose, potassium, tromethamine, and 50% dextrose
followed by normal blood. Evaluation of stroke work index after 60 minutes
of recovery (as percent of control) was performed using the isolated, blood
perfused, working heart preparation in all groups: Group I (Stanford
cardioplegia, saline storage, normal blood reperfusion) had a recovery of
11%; group II (Stanford + calcium, saline, normal blood) 8%; group III
(Stanford + calcium, saline, modified blood, superoxide dismutase 35,000
U/L, catalase 35,000 U/L) 37%; group IV (Stanford + calcium, Sacks II,
modified blood, superoxide dismutase 35,000 U/L, catalase 35,000 U/L), 47%;
group V (Stanford + calcium, Sacks + glucose, modified blood, superoxide
dismutase 35,000 U/L, catalase 105,000 U/L) 89%; group VI (Stanford +
calcium, Sacks + glucose, modified blood, superoxide dismutase 150,000 U/L,
catalase 150,000 U/L) 107%; group VII (Sacks + glucose, Sacks + glucose,
modified blood, superoxide dismutase 35,000 U/L, catalase 105,000 U/L)
115%. Conclusions: The neonatal heart stored hypothermically for 12 hours
tolerates normal blood reperfusion poorly. Modified blood reperfusion
markedly improves the recovery. Complete functional recovery was achieved
by the intracellular Sacks plus glucose storage solution and modified blood
reperfusion with oxygen- derived free radical scavengers (high catalase).
Extended preservation of the neonatal heart is feasible.
