Heart preservation using continuous ex vivo perfusion improves viability and functional recovery.
BACKGROUND
Cold static storage (CS) is a proven preservation method for heart transplantion, yet early postoperative graft dysfunction remains prevalent, so continuous perfusion (CP) during ex vivo transport may improve viability and function of heart grafts.


RESULTS
Canine hearts underwent CP (n=9) or CS (n=9) for 6 h while intramyocardial pH was continuously monitored. Biopsies were assayed for ATP, caspase-3, malondialdehyde (MDA), and endothelin-1 (ET-1) levels at baseline, after preservation (t1), and after 1 h of blood reperfusion on a Langendorff model (t2). Functional recovery was determined at t2 by +dP/dt, -dP/dt, developed pressure, peak pressure and end-diastolic pressure. CP resulted in higher tissue pH and ATP stores and reduced caspase-3, MDA and ET-1 levels compared with CS at both t1 and t2. Post reperfusion recovery was significantly greater in CP vs CS for all myocardial functional parameters except end-diastolic pressure. Weight gain was significantly increased in CP vs CS at t1, but not at t2.


CONCLUSIONS
Low-grade tissue acidosis and energy depletion occur during CS and are associated with oxidative injury and apoptosis during reperfusion. CP attenuates these biochemical and pathologic manifestations of tissue injury, together with improved myocardial recovery, despite mild, transient edema.
Ozeki
Toshinaga
T
Division of Cardiac Surgery, University of Maryland School of Medicine and VA Medical Center at Baltimore 21201, USA.
Kwon
Michael H
MH
Gu
Junyan
J
Collins
Michael J
MJ
Brassil
John M
JM
Miller
Michael B
MB
Gullapalli
Rao P
RP
Zhuo
Jiachen
J
Pierson
Richard N
RN
Griffith
Bartley P
BP
Poston
Robert S
RS
D000255:Adenosine Triphosphate / Q000378:metabolism; D000818:Animals; D017209:Apoptosis / Q000502:physiology; D053148:Caspase 3 / Q000378:metabolism; D004285:Dogs; D019332:Endothelin-1 / Q000378:metabolism; D006321:Heart / Q000502:physiology*; D016027:Heart Transplantation / Q000379:methods*; D006863:Hydrogen-Ion Concentration; D008315:Malondialdehyde / Q000378:metabolism; D009206:Myocardium / Q000378:metabolism; D009926:Organ Preservation / Q000379:methods*; D010477:Perfusion / Q000379:methods*; D015427:Reperfusion Injury / Q000503:physiopathology / Q000517:prevention & control; D013696:Temperature; D014022:Tissue Survival / Q000502:physiology*; D016277:Ventricular Function, Left / Q000502:physiology
D019332:Endothelin-1; D008315:Malondialdehyde; D000255:Adenosine Triphosphate; D053148:Caspase 3