Rosenstrauch Doreen, Akay Hakan M, Bolukoglu Hakki, Behrens Lars, Bryant Laura, Herrera Peter, Eya Kazuhiro, Tuzun Egemen, Clubb Fred J, Radovancevic Branislav, Frazier O H, Kadipasaoglu Kamuran A
Cullen Cardiovascular Research Laboratories, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77030, USA.
Tex Heart Inst J. 2003;30(2):121-7.
One possible way to expand the human heart donor pool is to include non-heart-beating human donors. To begin validating this approach, we developed an ex vivo cardiac perfusion circuit to support large mammalian hearts in Langendorff mode and beating-ejecting mode and to assess and improve their ischemic tolerance. In vivo hemodynamic data and heparinized blood (4.0 +/- 0.5 L) were collected from 6 anesthetized pigs. Hearts were isolated and connected to a recirculating perfusion circuit primed with autologous buffered blood (pH, 7.40). After retrograde aortic perfusion in Langendorff mode, the left atrium was gravity-filled at 10-20 mmHg, and the left ventricle began to eject against a compliance chamber in series with a systemic reservoir set to a hydraulic afterload of 100-120 mmHg. Left ventricular function was restored and maintained in all 6 hearts for 30 min. Cardiac output, myocardial oxygen consumption, stroke work, aortic pressure, left atrial pressure, and heart rate were measured. The mean myocardial oxygen consumption was 4.8 +/- 2.7 mL/min/100 g (95.8% of in vivo value); and mean stroke work, 5.3 +/- 1.1 g x m/100 g (58.95% of in vivo value). One resuscitated heart was exposed to 30 min of normothermic ischemic arrest, then flushed with Celsior and re-resuscitated. The ex vivo perfusion method described herein restored left ventricular ejection function and allowed assessment of ischemic tolerance in large mammalian hearts, potentially a 1st step toward including non-heart-beating human donors in the human donor pool.
扩大人类心脏供体库的一种可能方法是纳入非心脏跳动的人类供体。为了开始验证这种方法，我们开发了一种体外心脏灌注回路，以在Langendorff模式和跳动-射血模式下支持大型哺乳动物心脏，并评估和提高其缺血耐受性。从6只麻醉猪身上收集体内血流动力学数据和肝素化血液（4.0±0.5升）。分离心脏并连接到用自体缓冲血液（pH值7.40）预充的循环灌注回路。在Langendorff模式下进行逆行主动脉灌注后，左心房在10-20 mmHg压力下重力充盈，左心室开始对着与设置为100-120 mmHg液压后负荷的体循环储液器串联的顺应性腔室射血。所有6颗心脏的左心室功能均恢复并维持30分钟。测量心输出量、心肌耗氧量、每搏功、主动脉压力、左心房压力和心率。平均心肌耗氧量为4.8±2.7 mL/min/100 g（为体内值的95.8%）；平均每搏功为5.3±1.1 g·m/100 g（为体内值的58.95%）。一颗复苏的心脏经历30分钟的常温缺血性停搏，然后用Celsior冲洗并再次复苏。本文所述的体外灌注方法恢复了左心室射血功能，并允许评估大型哺乳动物心脏的缺血耐受性，这可能是将非心脏跳动的人类供体纳入人类供体库的第一步。
