Document Type

Article

Language

eng

Publication Date

9-2008

Publisher

Elsevier

Source Publication

The Journal of Heart and Lung Transplantation

Source ISSN

1053-2498

Original Item ID

DOI: 10.1016/j.healun.2008.05.028

Abstract

Background

Donor human hearts cannot be preserved for >5 hours between explantation and recipient implantation. A better approach is needed to preserve transplantable hearts for longer periods, ideally at ambient conditions for transport. We tested whether Lifor solution could satisfactorily preserve guinea pig isolated hearts perfused at low flow with no added oxygen at room temperature for 20 hours.

Methods

Hearts were isolated from 18 guinea pigs and perfused initially with oxygenated Krebs–Ringer (KR) solution at 37°C. Hearts were then perfused with recirculated Lifor or cardioplegia (CP) solution (K+ 15 mmol/liter) equilibrated with room air at 20% of control flow at 26°C for 20 hours. Hearts were then perfused at 100% flow with KR for 2 hours at 37°C.

Results

Lifor and CP arrested all hearts. During the 20-hour low-flow perfusion with Lifor coronary pressure increased by 6 ± 2 mm Hg and percent oxygen extraction by 29 ± 2%, whereas oxygen consumption (MVo2) decreased by 74 ± 4%. Similar changes were noted for CP, except that MVo2 was decreased by 86 ± 7%. After 20-hour low-flow perfusion with Lifor and 2 hours of warm reperfusion with KR solution, diastolic left ventricular pressure (LVP), maximal dLVP/dt and percent oxygen extraction returned completely to baseline values, whereas heart rate returned to 80 ± 3%, developed LVP to 76 ± 3%, minimal dLVP/dt (relaxation) to 65 ± 4%, coronary flow to 80 ± 4%, oxygen consumption to 82 ± 4% and cardiac efficiency to 85 ± 4% of baseline values. Flow responses to adenosine and nitroprusside after Lifor treatment were 65 ± 3% and 64 ± 3% of their baseline values. After cardioplegia, treatment there was no cardiac activity, with a diastolic pressure of 35 ± 14 mm Hg and a return of coronary flow to only 45 ± 3% of baseline value.

Conclusions

Compared with a cardioplegia solution at ambient air and temperature conditions, Lifor solution is a much better medium for long-term cardiac preservation in this model.

Comments

NOTICE: this is the author’s version of a work that was accepted for publication in The Journal of Heart and Lung Transplantation. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in The Journal of Heart and Lung Transplantation, Vol. 27, No. 9 (September 2008): 1008–1015. DOI. © 2008 Elsevier. Used with permission.

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