Cardiac preservation in patients undergoing transplantation. A clinical trial comparing University of Wisconsin solution and Stanford solution.
Recent laboratory investigations have shown significantly improved donor heart preservation and function when the University of Wisconsin solution (UW) is used for arrest and storage. These findings prompted us to compare UW to Stanford solution in a clinical trial. After giving informed consent, patients were blindly randomized to receive a heart arrested and stored in UW or a heart arrested in Stanford solution and stored in normal saline. Orthotopic transplants were performed in a routine manner. Fourteen patients with a mean age of 54 years were randomized to UW, and 15 patients with a mean age of 51 years were randomized to Stanford solution. Mean donor ages (UW 27 years, Stanford 24 years) and ischemic times (UW 150 minutes, Stanford 135 minutes) were similar. Several differences were observed intraoperatively. At end ischemia, mean adenosine triphosphate (UW 5.87 mmol/gm wet weight, Stanford 4.75 mmol/gm) and creatine phosphate (UW 9.26 mmol/gm, Stanford 4.75 mmol/gm) levels were higher in the UW hearts (p less than 0.05). Defibrillation requirements (UW 14% [2/14], Stanford 53% [8/15]) were significantly less in the UW group (p = 0.05). The number of patients requiring temporary intraoperative pacing also showed a significant difference with 7% (1/14) of UW patients versus 47% (7/15) of Stanford patients requiring pacing (p less than 0.05). Intraoperative requirement for inotropic support showed a trend in favor of the UW group. End-ischemic and postreperfusion histologic characteristics were similar between the two groups. No differences in hemodynamics or ejection fractions were noted postoperatively, but trends toward improved rhythm and decreased inotropic support were present in the UW group. Overall 6-month survival rates were similar (UW 86% [12/14], Stanford 93% [14/15]). No preservation-related deaths occurred. We conclude: (1) UW is a safe and effective preservation solution for human cardiac transplantation; (2) considering the improved end-ischemic adenosine triphosphate and creatine phosphate levels, decreased defibrillations, decreased intraoperative pacing, and trend toward decreased requirement for inotropic support in the UW group, UW appears to be superior to Stanford solution for donor heart preservation.
Division of Cardiothoracic Surgery, University of California, Los Angeles Medical Center.
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Stein
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Drinkwater
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Laks
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Permut
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Sangwan
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Chait
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Child
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Bhuta
D000255:Adenosine Triphosphate / Q000097:blood; D000328:Adult; D000368:Aged; D002314:Cardioplegic Solutions; D004298:Dopamine / Q000008:administration & dosage; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006321:Heart; D016027:Heart Transplantation / Q000401:mortality / Q000502:physiology; D006801:Humans; D007432:Intraoperative Period; D007545:Isoproterenol / Q000008:administration & dosage; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation / Q000379:methods*; D010725:Phosphocreatine / Q000097:blood; D011184:Postoperative Period; D015996:Survival Rate; D014922:Wisconsin
D002314:Cardioplegic Solutions; D010725:Phosphocreatine; D000255:Adenosine Triphosphate; D007545:Isoproterenol; D004298:Dopamine