Cold storage of the heart with University of Wisconsin solution and 2,3-butanedione monoxime: Langendorff vs isolated working rabbit heart model.
Currently, for clinical heart preservation with University of Wisconsin (UW) solution the ischemic time is limited to 8 h. The reliable preservation of the heart for 24 h or more would have a dramatic impact on the existing practice of cardiac transplantation. We showed previously [J. Thorac. Cardiovasc. Surg. 107; 764-775 (1994)] that experimentally preservation could be extended to 24-30 h by preventing ischemic contracture of the heart with 2, 3-butanedione monoxime (BDM) in the UW solution (UWBDM). This resulted in nearly 100% return of function as tested in the isolated crystalloid-reperfused rabbit heart in the nonworking Langendorff preparation. We have confirmed these results and now have measured the function of hearts stored in UWBDM for 2, 4, 12, and 24 h using the isolated working rabbit heart model. Preservation in UWBDM solution resulted in a biphasic decrease of cardiac output. In the hearts preserved for 2-12 h the decrease of function averaged 20-35% upon reperfusion, and the differences at 2, 4, or 12 h were not significant (analysis of variance p > 0.05). A more pronounced decrease of 64% was obtained after 24 h of cold storage. Hearts preserved for 24 h without BDM were practically nonfunctional. The release of enzymes (creatine kinase and lactate dehydrogenase) followed biphasic pattern similar to that of cardiac output: a small release between 2 and 12 h and larger, significant losses at 24 h. Although we originally proposed that hearts preserved with UWBDM for 24 h were well preserved (Langendorff model), we now show that poor function was obtained at 24 h. The difference was that in this study we used a more rigorous, isolated working rabbit heart model to test the function of the preserved heart, and this may be a better test of preservation quality.
Lopukhin
S Y
SY
Department of Surgery, University of Wisconsin Hospital, Madison, Wisconsin, 53792, USA.
Peek
D F
DF
Southard
J H
JH
Belzer
F O
FO
D000241:Adenosine; D000255:Adenosine Triphosphate / Q000378:metabolism; D000493:Allopurinol; D000818:Animals; D002302:Cardiac Output; D003080:Cold Temperature; D003931:Diacetyl / Q000031:analogs & derivatives; D005069:Evaluation Studies as Topic; D005978:Glutathione; D006321:Heart / Q000502:physiology; D066298:In Vitro Techniques; D007328:Insulin; D008954:Models, Biological; D009926:Organ Preservation / Q000379:methods*; D019188:Organ Preservation Solutions; D011817:Rabbits; D011887:Raffinose; D013997:Time Factors
D007328:Insulin; D019188:Organ Preservation Solutions; C055206:University of Wisconsin-lactobionate solution; C004717:diacetylmonoxime; D000493:Allopurinol; D000255:Adenosine Triphosphate; D005978:Glutathione; D003931:Diacetyl; D000241:Adenosine; D011887:Raffinose