"Cardioplegia on the contractile apparatus level": evaluation of a new concept for myocardial preservation in perfused pig hearts.
The concept of a reversible desensitization of the myocardial contractile apparatus for calcium by 2,3 Butanedione Monoxime (BDM) as a method to improve the myocardium's tolerance to cold ischemia was evaluated in normal pig hearts (n = 14). The results were compared to those obtained after application of Bretschneider's HTK cardioplegic solution.


METHODS
Series I) After BDM treatment (concentrations: 0-30 mmol/L) the isometric force output and the intracellular calcium transients (measured using the FURA-2 ratio method) of electrically driven (1 Hz) isolated left-ventricular muscle strips excised from beating pig hearts (n = 14) were recorded simultaneously in order to analyse the mode of action of BDM; Series II) The cardioprotective effects of BDM (30 mmol/L) and Bretschneider's cardioplegic solution (HTK) were compared in a large-animal model: after "in situ perfusion" of pig hearts with either 2000 ml ice-cold BDM solution (30 mmol/L) (n = 7) or 2000 ml HTK (n = 7) the hearts were explanted and stored at 4 degrees C in the same solutions for up to 42 h. The contractile properties of muscle fibres, excised after storage periods of 8, 24, and 42 h from these hearts were analyzed in terms of isometric force development and isotonic shortening. 280 muscle fibres from 14 pigs were used for measurements.


RESULTS
Series I) In pig myocardium a dose-dependent reduction of isometric force development was found after BDM application. The shape and the amplitude of the intracellular calcium transient were also affected by BDM. At 30 mmol/L BDM no force development could be elicited despite the presence of an intracellular calcium transient (amplitude < 70% of the control). Series II) Shortening, calcium transient, and force of left-ventricular muscle strips of pig myocardium excised after storage periods for up to 42 h showed complete recovery when BDM was applied. In contrast HTK perfusion allowed complete recovery of these parameters when the storage period did not exceed 6 hours.


CONCLUSIONS
Under the given experimental conditions reversible desensitization of the contractile apparatus for calcium results in a considerable prolongation of the tolerance to cold ischemia in explanted pig hearts. The present study shows that the protective effects of BDM are not only present when isolate muscle fibres were stored (and the extracellular space is large) but also after storage of complete hearts in a solution in a solution containing BDM. Thus BDM may become a useful agent to enlarge the storage period of donor hearts in heart transplatation considerably.
Vahl
C F
CF
Department of Cardiac Surgery, Heidelberg University, Germany.
Bonz
A
A
Hagl
C
C
Timek
T
T
Herold
U
U
Fuchs
H
H
Kochsiek
N
N
Hagl
S
S
D000818:Animals; D015220:Calcium Channels / Q000187:drug effects; D002314:Cardioplegic Solutions / Q000494:pharmacology*; D003931:Diacetyl / Q000031:analogs & derivatives* / Q000494:pharmacology; D004305:Dose-Response Relationship, Drug; D004562:Electrocardiography; D005947:Glucose / Q000494:pharmacology; D006324:Heart Arrest, Induced / Q000379:methods*; D066298:In Vitro Techniques; D007537:Isometric Contraction / Q000187:drug effects; D007551:Isotonic Contraction / Q000187:drug effects; D008353:Mannitol / Q000494:pharmacology; D009200:Myocardial Contraction / Q000187:drug effects*; D009926:Organ Preservation / Q000379:methods*; D011189:Potassium Chloride / Q000494:pharmacology; D011343:Procaine / Q000494:pharmacology; D013552:Swine; D013997:Time Factors
C039984:Bretschneider cardioplegic solution; D015220:Calcium Channels; D002314:Cardioplegic Solutions; C004717:diacetylmonoxime; D008353:Mannitol; D011343:Procaine; D011189:Potassium Chloride; D005947:Glucose; D003931:Diacetyl