Coronary oxygen persufflation combined with HTK cardioplegia prolongs the preservation time in heart transplantation.
BACKGROUND
One of the most restricting factors remaining in heart transplantation is the limited myocardial ischemia time. A new approach towards the prolongation of this time is the combination of primary cardioplegic arrest followed by continuous coronary oxygen persufflation (COP) with gaseous oxygen.


METHODS
This technique was applied in pig hearts, which we transplanted orthotopically after cardioplegic arrest by original (n = 5) and modified (addition of hyaluronidase: n = 11) Bretschneider HTK solution and 14 h of hypothermic preservation. Depending on the different preservation techniques, we created four groups: (1), original HTK (HTK), n = 5; (2), modified HTK (mHTK), n = 5; (3), modified HTK solution plus COP (mHTK + COP), n = 6; and (4), as a control five hearts were transplanted after cardioplegic arrest by the original HTK solution and a cold ischemia time of 3 h comparable to clinical routine procedure.


RESULTS
After 14 h of preservation and orthotopic transplantation, cardiac functional recovery in mHTK + COP hearts was similar to control hearts, and improved compared to hearts of both other groups. Hemodynamics were significantly better in hearts preserved by mHTK + COP and in the control group compared to the HTK-hearts (P < 0.05), not significant compared to mHTK hearts (dp/dt(max) in % of preoperative +/- standard error of mean (SEM): mHTK + COP, 85 +/- 9; control, 85 +/- 10.5; mHTK, 59 +/- 14; HTK, 50 +/- 4). The cardiac output (CO) in % of preoperative was: mHTK + COP, 68 +/- 5.4; control, 64 +/- 4; mHTK, 44 +/- 2.7; HTK, 25 +/- 11. The ATP of left ventricular myocardium in mHTK + COP hearts at 14.7 +/- 1 micromol/g dry weight (DW) and in the control at 14.59 +/- 1.8 was higher compared to that in mHTK at 12.2 +/- 2.8 (P is non-significant (n.s.) versus mHTK + COP and control) and in HTK-hearts at 7.0 +/- 0.5 (P < 0.05 versus mHTK + COP and control). CK-MB in percent of CK showed no increase in either group.


CONCLUSIONS
These data show that COP combined with a mHTK solution represents a potential alternative to complement currently used cold storage techniques for prolonged preservation periods.
Kuhn-Régnier
F
F
Department of Cardiothoracic Surgery, University of Cologne, Germany. ferdinand.kuhn-regnier@medizin.uni-koeln.de
Fischer
J H
JH
Jeschkeit
S
S
Switkowski
R
R
Bardakcioglu
O
O
Sobottke
R
R
de Vivie
E R
ER
D000818:Animals; D002314:Cardioplegic Solutions / Q000627:therapeutic use*; D003402:Creatine Kinase / Q000378:metabolism; D005947:Glucose / Q000627:therapeutic use; D006321:Heart; D006324:Heart Arrest, Induced / Q000379:methods*; D016027:Heart Transplantation / Q000502:physiology*; D006439:Hemodynamics; D007527:Isoenzymes; D008353:Mannitol / Q000627:therapeutic use; D009206:Myocardium / Q000378:metabolism; D009926:Organ Preservation; D010100:Oxygen / Q000627:therapeutic use*; D010101:Oxygen Consumption; D011189:Potassium Chloride / Q000627:therapeutic use; D011343:Procaine / Q000627:therapeutic use; D013552:Swine
C039984:Bretschneider cardioplegic solution; D002314:Cardioplegic Solutions; D007527:Isoenzymes; D008353:Mannitol; D011343:Procaine; D011189:Potassium Chloride; D003402:Creatine Kinase; D005947:Glucose; D010100:Oxygen