Extended ex vivo preservation of the heart and lungs. Effects of acellular oxygen-carrying perfusates and indomethacin on the autoperfused working heart-lung preparation.
The autoperfused working heart-lung preparation has been proposed as a method for long-term heart-lung preservation. We investigated the effects of acellular oxygen-carrying perfusates (study 1) and the effect of donor pretreatment with indomethacin (study 2) on the working ex vivo heart-lung block. In study 1 perfusion with stroma-fee hemoglobin resulted in significantly reduced survival (118 +/- 46 minutes) compared with autologous blood (561 +/- 125 minutes, p less than 0.05) or perfluorocarbon (438 +/- 114 minutes, p less than 0.05). Decrease in survival with stroma-free hemoglobin perfusate is associated with a marked decrease in left ventricular performance and a significant increase in pulmonary vascular resistance. Perfusion with autologous blood is associated with a significant increase in pulmonary vascular resistance after 240 minutes of explantation, which is significantly delayed by perfusion with perfluorocarbon. Perfusion for 6 hours with blood pretreated with indomethacin (study 2) resulted in a decrease in the concentration of prostacyclin and thromboxane A2 metabolites but an increase in the prostaglandin/thromboxane A2 metabolite ratio. This is associated with abrogation of the increase in pulmonary vascular resistance (12,787 +/- 1682 dynes/sec/cm-5, T = 0; 13,134 +/- 2654 dynes/sec/cm-5, T = 360 minutes) observed in preparations perfused with autologous blood (13,194 +/- 1942 dynes/sec/cm-5, T = 0; 24,768 +/- 3325 dynes/sec/cm-5, T = 360 minutes, p less than 0.05). We conclude that alteration of the cellular and humoral components of autologous blood may prove advantageous for increasing the utility of the autoperfused working heart-lung preparation as a preservation technique.
Kaplan
E
E
Department of Surgery, Tufts University School of Medicine, Boston, Mass.
Diehl
J T
JT
Peterson
M B
MB
Somerville
K H
KH
Daly
B D
BD
Connolly
R J
RJ
Cooper
A G
AG
Seiler
S D
SD
Cleveland
R J
RJ
D000818:Animals; D001769:Blood; D011464:Epoprostenol / Q000096:biosynthesis; D005466:Fluorocarbons; D016027:Heart Transplantation; D006454:Hemoglobins; D066298:In Vitro Techniques; D007213:Indomethacin / Q000494:pharmacology; D008168:Lung / Q000187:drug effects / Q000378:metabolism / Q000473:pathology; D008170:Lung Compliance; D016040:Lung Transplantation; D008297:Male; D009926:Organ Preservation / Q000379:methods; D010477:Perfusion; D011652:Pulmonary Circulation; D011817:Rabbits; D013929:Thromboxane B2 / Q000096:biosynthesis; D014022:Tissue Survival; D014655:Vascular Resistance
D005466:Fluorocarbons; D006454:Hemoglobins; D013929:Thromboxane B2; D011464:Epoprostenol; D007213:Indomethacin