title: The optimal pressure for initial flush with UW solution in heart procurement.
abstract: OBJECTIVE
  University of Wisconsin (UW) solution is widely used in organ preservation. Some investigators have reported that high pressure during initial flush with UW solution may induce vasoconstriction and endothelial damage, because of its high potassium content and high viscosity. However, using lower pressure during the initial flush may lead to irregular distribution of the solution and incomplete flushing of blood components from coronary vascular beds. This experimental study evaluated the effects of a range of initial flush pressures during heart procurement, followed by orthotopic transplantation of the graft after 12 hours of preservation.
  
  
  METHODS
  Twelve pairs of adult mongrel dogs, weighing 9 to 14 kg, formed the recipient-donor combinations. After determining hemodynamic status by measuring cardiac output, left ventricular pressure (LVP), and maximum positive and negative change in LVP (+/-LVdP/dt), donor hearts were excised. Coronary vascular beds were flushed with 4 degrees C UW solution at a pressure of 60 mm Hg in the low-pressure group (n = 6) and at 120 mm Hg in the high-pressure group (n = 6). After 12 hours of cold preservation, orthotopic transplantation was performed using cardiopulmonary bypass (CPB). The hemodynamics of the transplanted graft were assessed by comparing recovery rates (%) from donor hearts 2 hours after weaning from CPB. Endothelin-1 (ET-1) levels were measured in the blood obtained from the coronary sinus 30 minutes after reperfusion. The transplanted grafts were then harvested for histologic study and measurement of adenosine triphosphate (ATP) content.
  
  
  RESULTS
  Cardiac output, LVP, LVdP/dt and myocardial tissue ATP content were significantly better (p < 0.05) in the high-pressure group than in the low-pressure group. We found no significant differences in ET-1 levels between the groups. Transmission electron microscopic findings revealed that degeneration of the mitochondria was less extensive in the high-pressure group than in the low-pressure group. We observed no obvious ultrastructural damage to the endothelial cells in either group.
  
  
  CONCLUSIONS
  When using UW solution in heart procurement, high pressure is better to completely wash out the blood components and distribute the solution.
authors.affiliation: Second Department of Surgery, Gunma University School of Medicine, Maebashi, Gunma, Japan. tcvjun@cb3.so-net.ne.jp
authors.forename: Jun
authors.initials: J
authors.lastname: Mohara
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Tsutsumi
authors.forename: Izumi
authors.initials: I
authors.lastname: Takeyoshi
authors.forename: Masahiko
authors.initials: M
authors.lastname: Tokumine
authors.forename: Masahiro
authors.initials: M
authors.lastname: Aizaki
authors.forename: Susumu
authors.initials: S
authors.lastname: Ishikawa
authors.forename: Koshi
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Morishita
mesh_terms: D000241:Adenosine; D000255:Adenosine Triphosphate / Q000032:analysis; D000493:Allopurinol; D000818:Animals; D004285:Dogs; D019332:Endothelin-1 / Q000097:blood; D004730:Endothelium, Vascular / Q000648:ultrastructure; D005978:Glutathione; D006321:Heart; D016027:Heart Transplantation; D006439:Hemodynamics; D007328:Insulin; D009206:Myocardium / Q000737:chemistry / Q000473:pathology; D019188:Organ Preservation Solutions; D011312:Pressure; D011887:Raffinose; D013048:Specimen Handling
chemical_list: D019332:Endothelin-1; D007328:Insulin; D019188:Organ Preservation Solutions; C055206:University of Wisconsin-lactobionate solution; D000493:Allopurinol; D000255:Adenosine Triphosphate; D005978:Glutathione; D000241:Adenosine; D011887:Raffinose