Saitoh Y, Hashimoto M, Ku K, Kin S, Nosaka S, Masumura S, Nakayama K
First Department of Surgery, Shimane Medical University, Izumo, Japan.
Ann Thorac Surg. 2000 Jan;69(1):107-12. doi: 10.1016/s0003-4975(99)01190-x.
Poor myocardial tolerance to prolonged cold ischemia remains a major concern in heart transplantation. In this study, we estimated superiority of Histidine-Tryptophan-Ketoglutarate (HTK) over University of Wisconsin (UW) as a cardiac preservation solution.
Isolated rat hearts were mounted on a Langendorff apparatus to estimate the baseline cardiac function. The hearts were arrested and stored at 4 degrees C in UW and HTK solution for 8 hours, and then reperfused. The aortic flow, coronary flow, cardiac output, rate pressure product, and left ventricular dp/dt in the HTK group recovered significantly more than the UW group. The values of myocardial total adenine nucleotides and the adenosine triphosphate to adenosine diphosphate ratio were higher in the HTK than in the UW group. We also examined coronary vascular responsiveness using left coronary arteries dissected from the rat hearts before flushing, before storage, after storage, and after reperfusion.
The maximal relaxation response to acetylcholine was significantly higher in the HTK than in the UW group after reperfusion, although there were no significant differences at each stage before reperfusion. In addition, the endothelium-independent relaxation response to sodium nitroprusside in the HTK group was also well preserved after reperfusion.
These results indicate that HTK is superior to UW solution for cardiac preservation. HTK protects coronary vasculature during preservation, which together with reperfusion might lead to improved functional cardiac recovery following preservation.
心肌对长时间冷缺血的耐受性较差仍是心脏移植中的一个主要问题。在本研究中，我们评估了组氨酸 - 色氨酸 - 酮戊二酸（HTK）作为心脏保存液相对于威斯康星大学（UW）溶液的优势。
将离体大鼠心脏安装在Langendorff装置上以评估基线心脏功能。心脏停搏后，分别置于UW溶液和HTK溶液中，在4℃下保存8小时，然后再灌注。HTK组的主动脉流量、冠状动脉流量、心输出量、心率血压乘积和左心室dp/dt恢复情况明显优于UW组。HTK组心肌总腺嘌呤核苷酸值及三磷酸腺苷与二磷酸腺苷的比值高于UW组。我们还使用从大鼠心脏分离的左冠状动脉，在冲洗前、保存前、保存后和再灌注后检查了冠状动脉血管反应性。
再灌注后，HTK组对乙酰胆碱的最大舒张反应明显高于UW组，尽管在再灌注前的各个阶段两组之间无显著差异。此外，HTK组对硝普钠的非内皮依赖性舒张反应在再灌注后也得到了很好的保留。
这些结果表明，HTK作为心脏保存液优于UW溶液。HTK在保存过程中可保护冠状动脉血管，这与再灌注一起可能会改善保存后心脏功能的恢复。
