The effect of short-term coronary perfusion using oxygenated diluted blood following cold storage for long-term heart preservation.
BACKGROUND
The aim of this study was to compare the results obtained from the use of both University of Wisconsin (UW) solution and diluted blood in short-term coronary perfusion following 12-hour cold storage.


METHODS
Following coronary vascular washout of adult mongrel dogs with the UW solution, the heart was excised and immersed in a cold (4 degrees C) UW solution for 12 hours followed by 1-hour of coronary perfusion. Two different solutions were used for the coronary perfusion; a 4 degrees C oxygenated UW solution (Group U, n=7) and 15 degrees C oxygenated diluted blood (Group B, n=7). Myocardial high energy phosphate (HEP) levels, tissue water content (TWC), interstitial tissue space (ITS) rates and histological findings were evaluated at 0- and 12-hour cold storage and also following coronary perfusion. The preserved graft was then evaluated through orthotopic transplantation. The control group in this experiment consisted of seven hearts transplanted after 12-hour cold storage without coronary perfusion.


RESULTS
Myocardial HEP levels significantly decreased after 12-hour cold storage. The recovery rate of myocardial HEP levels after coronary perfusion was significantly (p<0.05) higher in Group B than in Group U. The increase of myocardial TWC during coronary perfusion was significantly (p<0.01) higher in Group B than in Group U. After 1-hour coronary perfusion, the subendocardial ITS rate was significantly (p<0.01) higher compared with the value at 0-hour cold storage in Group U, whereas it demonstrated no significant change in Group B. PAS stain revealed the glycogen content of the subendocardial tissues was higher in Group B than in Group U. The recovery rate of hemodynamic parameters 2 hours after heart transplantation was higher in Group U and significantly (p<0.05) higher in Group B than in the control.


CONCLUSIONS
Myocardial HEP levels recovered significantly after additional coronary perfusion. Though the UW solution prevented myocardial cellular edema, subendocardial perfusion was incomplete and the recovery rate of myocardial HEP levels was lower, suggesting that diluted blood may become the solution of choice as a perfusate.
Hasegawa
Y
Y
Second Department of Surgery, Gunma University School of Medicine, Maebashi, Japan.
Suzuki
M
M
Ohtaki
A
A
Takahashi
T
T
Sato
Y
Y
Ishikawa
S
S
Morishita
Y
Y
D000241:Adenosine / Q000008:administration & dosage; D000255:Adenosine Triphosphate / Q000378:metabolism; D000493:Allopurinol / Q000008:administration & dosage; D000818:Animals; D001793:Blood Preservation; D001803:Blood Transfusion / Q000379:methods*; D003080:Cold Temperature; D003331:Coronary Vessels; D004285:Dogs; D005978:Glutathione / Q000008:administration & dosage; D016027:Heart Transplantation / Q000379:methods* / Q000502:physiology; D006439:Hemodynamics / Q000187:drug effects; D006863:Hydrogen-Ion Concentration; D007261:Infusions, Intra-Arterial; D007328:Insulin / Q000008:administration & dosage; D015425:Myocardial Reperfusion / Q000379:methods*; D009206:Myocardium / Q000166:cytology / Q000378:metabolism*; D009926:Organ Preservation; D019188:Organ Preservation Solutions / Q000008:administration & dosage; D010100:Oxygen / Q000627:therapeutic use*; D010725:Phosphocreatine / Q000031:analogs & derivatives / Q000378:metabolism; D011300:Preoperative Care; D011887:Raffinose / Q000008:administration & dosage
D007328:Insulin; D019188:Organ Preservation Solutions; C055206:University of Wisconsin-lactobionate solution; D010725:Phosphocreatine; C025403:phosphocreatinine; D000493:Allopurinol; D000255:Adenosine Triphosphate; D005978:Glutathione; D000241:Adenosine; D011887:Raffinose; D010100:Oxygen