Improved preservation of coronary endothelial function with Celsior compared with blood and crystalloid solutions in heart transplantation.
BACKGROUND
Endothelial injury from preservation solutions has been implicated in acute coronary vasospasm and pathologic activation of the endothelium, which can contribute to the development of graft coronary vasculopathy after heart transplantation. Preservation solutions with a powerful antioxidant capacity may decrease the occurrence of these complications.


METHODS
This study was designed to evaluate the effect of Celsior (an anti-oxidant solution specifically designed for cardiac preservation) in a model of heart preservation (4 hours at 4 degrees C to reproduce the situation encountered in clinical heart transplantation) compared two commonly used cardioplegic and preservation strategies on coronary endothelial function. Endothelium-dependent relaxation of normal porcine epicardial coronary arteries to serotonin (5-HT, an agonist that activates 5-HT(1d) receptors coupled to Gi proteins) and bradykinin (BK, which activates B2 receptors coupled to Gq proteins) was studied in standard organ chamber experiments in the following groups: a control group was submitted to immediate excision without cardioplegia and preserved in saline solution (0.9% NaCl) for 4 hours (Group 1); two groups had cardioplegia induced with a crystalloid solution and were stored for 4 hours in saline (Group 2) or 4 hours in Celsior solution (Group 3); and two groups had cardioplegia induced with normothermic blood cardioplegia and were stored for 4 hours in the saline (Group 4), or 4 hours in Celsior solution (Group 5). Finally, two groups underwent cardioplegia with Celsior and were stored for 4 hours in saline (Group 6), or 4 hours in the Celsior solution (Group 7). All cardioplegia solutions were at 4 degrees C (except blood cardioplegia at 37 degrees C) and all preservations solutions were at 4 degrees C.


RESULTS
Endothelium-dependent relaxations to serotonin were significantly decreased in all groups except the Celsior + Celsior group compared with the control group. There were no significant differences in relaxation to bradykinin except in one group. Use of the Celsior solution for induction of cardioplegia and storage better preserved endothelium-dependent G-protein-mediated relaxation compared with the other arrest and preservation strategies.


CONCLUSIONS
The observed effect may be associated with an improvement in both short- and long-term outcome in heart transplantation, especially because these alterations may be further compounded by reperfusion.
Perrault
L P
LP
Research Center, Department of Surgery, Montreal Heart Institute, Quebec, Canada. lpperrau@icm.umontreal.ca
Nickner
C
C
Desjardins
N
N
Dumont
E
E
Thai
P
P
Carrier
M
M
D000818:Animals; D001920:Bradykinin / Q000097:blood / Q000494:pharmacology; D003331:Coronary Vessels / Q000187:drug effects; D004187:Disaccharides / Q000097:blood / Q000494:pharmacology; D004573:Electrolytes / Q000097:blood / Q000494:pharmacology; D004730:Endothelium, Vascular / Q000187:drug effects*; D016166:Free Radical Scavengers / Q000097:blood / Q000494:pharmacology; D005971:Glutamates / Q000097:blood / Q000494:pharmacology; D005978:Glutathione / Q000097:blood / Q000494:pharmacology; D016027:Heart Transplantation; D006639:Histidine / Q000097:blood / Q000494:pharmacology; D008353:Mannitol / Q000097:blood / Q000494:pharmacology; D023421:Models, Animal; D009200:Myocardial Contraction / Q000187:drug effects; D009926:Organ Preservation; D019188:Organ Preservation Solutions / Q000494:pharmacology*; D017680:Potassium Compounds / Q000097:blood / Q000494:pharmacology; D012701:Serotonin / Q000097:blood / Q000494:pharmacology; D012965:Sodium Chloride / Q000097:blood / Q000494:pharmacology; D013552:Swine
C088453:Celsior; D004187:Disaccharides; D004573:Electrolytes; D016166:Free Radical Scavengers; D005971:Glutamates; D019188:Organ Preservation Solutions; D017680:Potassium Compounds; C018369:potassium cardioplegic solution; D012701:Serotonin; D008353:Mannitol; D012965:Sodium Chloride; D006639:Histidine; D005978:Glutathione; D001920:Bradykinin