Serna D L, Powell L L, Kahwaji C, Wallace W C, West J, Cogert G, Smulowitz P, Steward E, Purdy R E, Milliken J C
Department of Pharmacology, UC Irvine Medical Center, Orange, California 92868, USA.
ASAIO J. 2000 Sep-Oct;46(5):547-52. doi: 10.1097/00002480-200009000-00007.
Efforts to extend myocardial preservation for transplantation by crystalloid perfusion have been limited by edema and compromised function. We hypothesized that hypothermic perfusion preservation with a polyethylene glycol (PEG) conjugated hemoglobin solution may extend preservation times. The purpose of this study was to compare cardiac function after continuous perfusion by using a hypocalcemic, normokalemic crystalloid perfusate with and without the addition of PEG-hemoglobin (Hb). The hearts of 20 anesthetized and ventilated New Zealand White rabbits were harvested after cold cardioplegic arrest. Group I (n = 10) hearts were continuously perfused with a hypocalcemic, normokalemic 3% bovine PEG-Hb solution at 20 degrees C and 30 mm Hg for 8 hours. Group II (n = 10) hearts were continuously perfused with an identical crystalloid solution without PEG-Hb for 8 hours under the same conditions as group I hearts. Cardiac function was measured with a left ventricular force transducer after transfer to a standard crystalloid Langendorff circuit at 37 degrees C and an aortic root pressure of 59 mm Hg. After 8 hours of perfusion preservation, heart rate was similar for groups I and II (p = not significant [NS]). Coronary blood flow after and during preservation was similar between PEG-Hb and crystalloid preserved hearts (p = NS). Left ventricular developed pressure, peak dP/dt, and peak -dP/dt were superior in hearts preserved with PEG-Hb. Percent water of total ventricular weight was 82.0% for group I and 81.6% for group II (p = NS). Continuous perfusion preservation of rabbit hearts for 8 hours with a hypocalcemic normokalemic PEG-Hb based solution at 30 mm Hg and 20 degrees C yields left ventricular function that is superior to perfusion with a similar crystalloid solution without PEG-Hb, despite similar myocardial edema and coronary flow. Extended cardiac perfusion preservation with this PEG-Hb based solution deserves further study, including comparison with traditional cardioplegic preservation solutions.
通过晶体灌注来延长用于移植的心肌保存时间的努力一直受到水肿和功能受损的限制。我们假设用聚乙二醇（PEG）共轭血红蛋白溶液进行低温灌注保存可能会延长保存时间。本研究的目的是比较使用添加和不添加PEG-血红蛋白（Hb）的低钙、正常血钾晶体灌注液连续灌注后的心脏功能。20只麻醉并通气的新西兰白兔在冷停搏后摘取心脏。第一组（n = 10）心脏在20℃和30mmHg下用低钙、正常血钾的3%牛PEG-Hb溶液连续灌注8小时。第二组（n = 10）心脏在与第一组心脏相同的条件下用不含PEG-Hb的相同晶体溶液连续灌注8小时。在转移到37℃、主动脉根部压力为59mmHg的标准晶体Langendorff循环后，用左心室力传感器测量心脏功能。灌注保存8小时后，第一组和第二组的心率相似（p = 无显著差异[NS]）。PEG-Hb保存的心脏和晶体保存的心脏在保存期间及之后的冠状动脉血流量相似（p = NS）。用PEG-Hb保存的心脏的左心室舒张末压、dp/dt峰值和 -dp/dt峰值更高。第一组心室总重量的含水量为82.0%，第二组为81.6%（p = NS）。在30mmHg和20℃下用基于低钙正常血钾PEG-Hb的溶液对兔心脏进行连续灌注保存8小时，尽管心肌水肿和冠状动脉血流量相似，但产生的左心室功能优于用不含PEG-Hb的类似晶体溶液灌注。用这种基于PEG-Hb的溶液进行延长的心脏灌注保存值得进一步研究，包括与传统的心脏停搏保存溶液进行比较。
