title: Effects of antegrade and retrograde machine perfusion preservation on cardiac function after transplantation in canines.
abstract: BACKGROUND
  Most studies investigating machine perfusion preservation for heart transplantation perfuse through the aortic root (antegrade), but the coronary sinus (retrograde) is a potential option. We hypothesized that retrograde machine perfusion provides better functional protection than static storage, while avoiding the potential irregular perfusion seen when aortic insufficiency occurs with antegrade perfusion.
  
  
  METHODS
  Eighteen canine donor hearts were arrested, procured, and stored in modified Celsior solution for 4 hours by using either static storage at 0°C to 4°C (n = 6) or machine perfusion preservation at 5°C via the aortic root (antegrade, n = 6) or coronary sinus (retrograde, n = 6). Lactate and myocardial oxygen consumption were measured in perfused hearts. Hearts were reimplanted and reperfused for 6 hours with hourly function calculated by using the preload recruitable stroke work (PRSW) relation. Myocardial water content was determined at the end of the experiment.
  
  
  RESULTS
  Storage lactate levels and myocardial oxygen consumption were comparable in both perfused groups. The PRSW was increased immediately after bypass in the antegrade group (120.6 ± 19.1 mm Hg) compared with the retrograde (75.0 ± 11.3 mm Hg) and static (78.1 ± 10.5 mm Hg) storage groups (P < .05). At the end of reperfusion, PRSW was higher in the retrograde group (69.8 ± 7.4 mm Hg) compared with the antegrade (40.1 ± 6.8 mm Hg) and static (39.9 ± 10.9 mm Hg) storage groups (P < .05). Myocardial water content was similar among groups.
  
  
  CONCLUSIONS
  Both antegrade and retrograde perfusion demonstrated excellent functional preservation, at least equivalent to static storage. Initial function was superior in the antegrade group, but the retrograde hearts displayed better function late after reperfusion. Neither perfused group developed significant edema. Machine perfusion preservation is a promising technique for improving results of cardiac transplantation.
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: sarah.brant@utsouthwestern.edu.
authors.forename: S M
authors.initials: SM
authors.lastname: Brant
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: D H
authors.initials: DH
authors.lastname: Rosenbaum
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: M L
authors.initials: ML
authors.lastname: Cobert
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: L M
authors.initials: LM
authors.lastname: West
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: M E
authors.initials: ME
authors.lastname: Jessen
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: M
authors.initials: M
authors.lastname: Peltz
mesh_terms: D000818:Animals; D004285:Dogs; D016027:Heart Transplantation / Q000662:veterinary*; D019188:Organ Preservation Solutions; D010101:Oxygen Consumption; D010477:Perfusion
chemical_list: D019188:Organ Preservation Solutions