title: Low-flow hypothermic crystalloid perfusion is superior to cold storage during prolonged heart preservation.
abstract: BACKGROUND
  Preservation of donor hearts for transplantation has traditionally been performed with the use of static cold storage. We have developed and tested a novel gravity-powered system of cold crystalloid perfusion for prolonged donor heart preservation.
  
  
  METHODS
  Greyhounds were anesthetized; their hearts were arrested with cold cardioplegic solution and excised. Hearts were allocated to 12 hours of perfusion preservation (n = 6) or cold storage in ice (n = 5). Non-preserved hearts (n = 5) served as a normal reference group. Perfusion hearts were perfused (20 mL/min, 8-12°C) with a novel oxygenated nutrient-containing preservation solution. After preservation, the recovery of the hearts was assessed in a blood-perfused working heart rig over 2 hours in terms of function, blood lactate level, myocardial adenosine triphosphate, and histology.
  
  
  RESULTS
  After 2 hours of reperfusion, in comparison with cold storage hearts, perfused heart function curves showed superior recovery of cardiac output (P = .001), power (P = .001), and efficiency (0.046 ± 0.01 vs 0.004 ± 0.003 joules/mL O2, P = .034). Myocardial adenosine triphosphate content (mmol/mg protein) was reduced significantly from the normal level of 26.5 (15.9, 55.8) to 5.08 (0.50, 10.4) (P = .049) in cold storage hearts but not in perfused hearts. Over a period of 2 hours, lactate levels in the blood perfusate were significantly lower in the perfusion group than in the cold storage group (P < .05).
  
  
  CONCLUSIONS
  Continuous hypothermic crystalloid perfusion provides myocardial preservation superior to cold storage for long-term heart preservation, with potential applicability to marginal and donation after circulatory death hearts.
authors.affiliation: Cardiac Surgical Research, Department of Cardiothoracic Surgery, Alfred Hospital, and the Department of Surgery, Monash University, Melbourne, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Ou
authors.affiliation: Cardiac Surgical Research, Department of Cardiothoracic Surgery, Alfred Hospital, and the Department of Surgery, Monash University, Melbourne, Australia.
authors.forename: Y W
authors.initials: YW
authors.lastname: Lim
authors.affiliation: Cardiac Surgical Research, Department of Cardiothoracic Surgery, Alfred Hospital, and the Department of Surgery, Monash University, Melbourne, Australia.
authors.forename: J W
authors.initials: JW
authors.lastname: Choong
authors.affiliation: Department of Cardiothoracic Surgery, Alfred Hospital, and the Department of Surgery, Monash University, Melbourne, Australia.
authors.forename: D S
authors.initials: DS
authors.lastname: Esmore
authors.affiliation: Department of Intensive Care, Alfred Hospital, Melbourne, Australia.
authors.forename: R F
authors.initials: RF
authors.lastname: Salamonsen
authors.affiliation: Department of Pathology, Alfred Hospital, Melbourne, Australia.
authors.forename: C
authors.initials: C
authors.lastname: McLean
authors.affiliation: Glycation and Diabetes, Baker IDI Heart and Diabetes Research Institute, Melbourne, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Forbes
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Bailey
authors.affiliation: Cardiac Surgical Research, Department of Cardiothoracic Surgery, Alfred Hospital, and the Department of Surgery, Monash University, Melbourne, Australia. Electronic address: f.rosenfeldt@alfred.org.au.
authors.forename: F L
authors.initials: FL
authors.lastname: Rosenfeldt
mesh_terms: D000818:Animals; D002314:Cardioplegic Solutions / Q000494:pharmacology*; D015925:Cryopreservation / Q000379:methods*; D000077324:Crystalloid Solutions; D004195:Disease Models, Animal; D004285:Dogs; D016027:Heart Transplantation; D007552:Isotonic Solutions / Q000494:pharmacology*; D009926:Organ Preservation / Q000379:methods*; D010477:Perfusion / Q000379:methods*
chemical_list: D002314:Cardioplegic Solutions; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions