Successful long-term preservation of the neonatal heart with a modified intracellular solution.
Current methods of myocardial preservation for transplantation are suboptimal. A newly developed intracellular cardioplegic and storage solution (modified University of Wisconsin solution, group 1) was compared in a randomized, blinded fashion with our present clinical protocol, Stanford cardioplegic solution and saline storage (group 2) in an isolated neonatal pig model. After arrest and storage for 12 hours at 4 degrees C, biopsy specimens were taken from six group 1 hearts and five group 2 hearts for examination under an electron microscope and assessment of high-energy phosphate levels and water content. The remainder (group 1, n = 7; group 2, n = 6) were reperfused with blood for 50 minutes, after which function curves were obtained at left ventricular end-diastolic pressures of 3 to 12 mm Hg and biopsy tissue was taken. Eight control hearts (group 3) were cannulated in situ and perfused on the circuit without arrest or intervening ischemia. Stroke and minute work index curves were approximately threefold and fivefold higher for group 1 (modified University of Wisconsin solution) than for group 2 (Stanford), respectively (p less than 0.01). The hearts preserved with University of Wisconsin solution did not differ in function from unpreserved control hearts (group 3). High-energy phosphate levels were better maintained in group 1 than group 2 (p less than 0.05), and water content was lower (p less than 0.01). Semiquantitative grading of electron micrographs paralleled the functional and biochemical results.


CONCLUSIONS
Modified University of Wisconsin intracellular solution provides markedly better heart preservation than conventionally used cardioplegic and storage solutions.
Breda
M A
MA
Division of Cardiothoracic Surgery, University of California, Los Angeles School of Medicine 90024-1741.
Drinkwater
D C
DC
Laks
H
H
Bhuta
S
S
Ho
B
B
Kaczer
E
E
Sebastian
J L
JL
Chang
P
P
D000241:Adenosine; D000493:Allopurinol; D000818:Animals; D000831:Animals, Newborn; D001639:Bicarbonates / Q000494:pharmacology; D002314:Cardioplegic Solutions / Q000494:pharmacology*; D005947:Glucose / Q000494:pharmacology; D005978:Glutathione; D006321:Heart; D016027:Heart Transplantation / Q000502:physiology*; D007328:Insulin; D008353:Mannitol / Q000494:pharmacology; D008854:Microscopy, Electron; D015428:Myocardial Reperfusion Injury / Q000473:pathology / Q000517:prevention & control*; D009206:Myocardium / Q000378:metabolism / Q000473:pathology; D009926:Organ Preservation / Q000379:methods*; D019188:Organ Preservation Solutions; D011189:Potassium Chloride / Q000494:pharmacology; D011887:Raffinose; D012965:Sodium Chloride / Q000494:pharmacology; D012996:Solutions / Q000494:pharmacology*; D013552:Swine; D013997:Time Factors
D001639:Bicarbonates; D002314:Cardioplegic Solutions; D007328:Insulin; D019188:Organ Preservation Solutions; D012996:Solutions; C046192:Stanford cardioplegic solution; C055206:University of Wisconsin-lactobionate solution; D008353:Mannitol; D012965:Sodium Chloride; D000493:Allopurinol; D011189:Potassium Chloride; D005978:Glutathione; D005947:Glucose; D000241:Adenosine; D011887:Raffinose