Effects of Celsior and University of Wisconsin preservation solutions on hemodynamics and endothelial function after cardiac transplantation in humans: a single-center, prospective, randomized trial.
Optimal preservation of the myocardium remains a major concern in clinical and experimental heart transplantation. The present study compared the efficacy of University of Wisconsin (UW) and Celsior preservation solution with respect to myocardial performance, epicardial and microvascular endothelial vasomotor function and myocardial expression of endothelin and nitric oxide synthases in humans. Forty-one cardiac transplant recipients received either UW (n = 20) or Celsior (n = 21) preserved hearts. Catecholamine and vasodilator requirements were assessed within the first 5 postoperative days. Left ventricular performance and endothelial function was assessed 1 month after transplantation. Endothelin and nitric oxide synthase gene expression were detected in myocardial biopsy samples. Celsior preserved hearts required significantly more catecholamines and vasodilators within the first 5 postoperative days. Myocardial performance and endothelial function were comparable 1 month after transplantation. Total ischemic time correlated with impaired endothelial function in the Celsior but not in the UW group. Endothelin and inducible nitric oxide synthase gene expression were significantly higher in the Celsior group. The results of the study show that both solutions provide myocardial protection with regard to left ventricular performance and endothelial function 1 month after cardiac transplantation. The necessity for higher vasodilator and catecholamine therapy in Celsior preserved hearts suggests post-ischemic myocardial stunning within the first 5 postoperative days. The positive correlation between impaired endothelial function and total ischemic time in the Celsior group requires longitudinal investigation in particular with regard to the development of allograft vasculopathy.
Wildhirt
S M
SM
Department of Cardiac Surgery, Grosshadern Hospital, Ludwig-Maximilians University, Munich, Germany. wildhirt@hch.med.uni-muenchen.de
Weis
M
M
Schulze
C
C
Conrad
N
N
Rieder
G
G
Enders
G
G
Ihnken
K
K
von Scheidt
W
W
Reichart
B
B
D000241:Adenosine; D000328:Adult; D000493:Allopurinol; D001794:Blood Pressure; D002395:Catecholamines / Q000627:therapeutic use; D004187:Disaccharides; D004573:Electrolytes; D016232:Endothelins / Q000097:blood / Q000235:genetics; D004730:Endothelium, Vascular / Q000502:physiology; D005260:Female; D005971:Glutamates; D005978:Glutathione; D006321:Heart; D016027:Heart Transplantation / Q000502:physiology*; D006439:Hemodynamics; D006639:Histidine; D006801:Humans; D007328:Insulin; D008297:Male; D008353:Mannitol; D008875:Middle Aged; D009200:Myocardial Contraction; D019001:Nitric Oxide Synthase / Q000235:genetics; D052247:Nitric Oxide Synthase Type II; D052250:Nitric Oxide Synthase Type III; D009926:Organ Preservation / Q000379:methods; D019188:Organ Preservation Solutions; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D011887:Raffinose; D012044:Regression Analysis; D014019:Tissue Donors / Q000706:statistics & numerical data; D014665:Vasodilator Agents / Q000627:therapeutic use
D002395:Catecholamines; C088453:Celsior; D004187:Disaccharides; D004573:Electrolytes; D016232:Endothelins; D005971:Glutamates; D007328:Insulin; D019188:Organ Preservation Solutions; C055206:University of Wisconsin-lactobionate solution; D014665:Vasodilator Agents; D008353:Mannitol; D006639:Histidine; D000493:Allopurinol; C496319:NOS2 protein, human; C496314:NOS3 protein, human; D019001:Nitric Oxide Synthase; D052247:Nitric Oxide Synthase Type II; D052250:Nitric Oxide Synthase Type III; D005978:Glutathione; D000241:Adenosine; D011887:Raffinose