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Transplant Proc. 2014 Dec;46(10):3309-13. doi: 10.1016/j.transproceed.2014.09.149.

Low-flow hypothermic crystalloid perfusion is superior to cold storage during prolonged heart preservation.

Author information

1
Cardiac Surgical Research, Department of Cardiothoracic Surgery, Alfred Hospital, and the Department of Surgery, Monash University, Melbourne, Australia.
2
Department of Cardiothoracic Surgery, Alfred Hospital, and the Department of Surgery, Monash University, Melbourne, Australia.
3
Department of Intensive Care, Alfred Hospital, Melbourne, Australia.
4
Department of Pathology, Alfred Hospital, Melbourne, Australia.
5
Glycation and Diabetes, Baker IDI Heart and Diabetes Research Institute, Melbourne, Australia.
6
Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia.
7
Cardiac Surgical Research, Department of Cardiothoracic Surgery, Alfred Hospital, and the Department of Surgery, Monash University, Melbourne, Australia. Electronic address: f.rosenfeldt@alfred.org.au.

Abstract

BACKGROUND:

Preservation of donor hearts for transplantation has traditionally been performed with the use of static cold storage. We have developed and tested a novel gravity-powered system of cold crystalloid perfusion for prolonged donor heart preservation.

METHODS:

Greyhounds were anesthetized; their hearts were arrested with cold cardioplegic solution and excised. Hearts were allocated to 12 hours of perfusion preservation (n = 6) or cold storage in ice (n = 5). Non-preserved hearts (n = 5) served as a normal reference group. Perfusion hearts were perfused (20 mL/min, 8-12°C) with a novel oxygenated nutrient-containing preservation solution. After preservation, the recovery of the hearts was assessed in a blood-perfused working heart rig over 2 hours in terms of function, blood lactate level, myocardial adenosine triphosphate, and histology.

RESULTS:

After 2 hours of reperfusion, in comparison with cold storage hearts, perfused heart function curves showed superior recovery of cardiac output (P = .001), power (P = .001), and efficiency (0.046 ± 0.01 vs 0.004 ± 0.003 joules/mL O2, P = .034). Myocardial adenosine triphosphate content (mmol/mg protein) was reduced significantly from the normal level of 26.5 (15.9, 55.8) to 5.08 (0.50, 10.4) (P = .049) in cold storage hearts but not in perfused hearts. Over a period of 2 hours, lactate levels in the blood perfusate were significantly lower in the perfusion group than in the cold storage group (P < .05).

CONCLUSIONS:

Continuous hypothermic crystalloid perfusion provides myocardial preservation superior to cold storage for long-term heart preservation, with potential applicability to marginal and donation after circulatory death hearts.

[Indexed for MEDLINE]

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