Chambers D J, Takahashi A, Hearse D J
Department of Cardiovascular Research, Rayne Institute, St. Thomas' Hospital, London U.K.
J Heart Lung Transplant. 1992 Jul-Aug;11(4 Pt 1):665-75.
Continuous hypothermic low-flow infusion of cardioplegic or other preservation solutions has been advocated for extending the maximum duration of storage of donor hearts for transplantation. We report the effect of varying the pressure during continuous infusion of St. Thomas' Hospital cardioplegic solution on functional recovery after long-term storage. Isolated working rat hearts (six per group) were aerobically perfused (20 minutes), and control indexes of cardiac function were measured; hypothermic ischemic arrest was then induced by a 3-minute infusion (60 cm H2O) of cold (7.5 degrees C) St. Thomas' Hospital cardioplegic solution. Hearts were then stored for 8 hours at 7.5 degrees C, either immersed in St. Thomas' Hospital cardioplegic solution (noninfused control) or continuously infused at varying infusion pressures with St. Thomas' Hospital cardioplegic solution, which had been both oxygenated and supplemented by the addition of glucose (11.1 mmol/L). After 8 hours of hypothermic ischemia, the rate of cardioplegic infusion was measured as an index of vascular resistance. The hearts were then reperfused (Langendorff) for 30 minutes during which creatine kinase leakage was measured. The hearts were then converted to working preparations for 20 minutes, and the recovery of contractile function was measured and expressed as a percentage of the preischemic control value. In hearts that had been subjected to continuous infusion at 6, 10, 20, 30, 40, and 60 cm H2O, the recoveries of aortic flow were 0% (p less than 0.05), 38.6% +/- 5.1% (p less than 0.05), 36.2% +/- 3.6% (p less than 0.05), 14.0% +/- 8.0%, 5.8% +/- 2.9%, and 9.9% +/- 4.7%, respectively, and the postischemic leakage of creatine kinase was 98.7 +/- 19.5 (p less than 0.05), 26.2 +/- 4.2, 15.5 +/- 3.4, 30.4 +/- 11.1, 109.8 +/- 21.8 (p less than 0.05), and 136.0 +/- 14.1 (p less than 0.05) IU/30 min/gm dry weight, respectively. In contrast, in noninfused control hearts the recovery of aortic flow was 11.1% +/- 7.5%, and creatine kinase leakage was 58.9 +/- 8.7 IU/30 min/gm dry weight. In conclusion, maximum myocardial preservation was obtained with continuous low-flow hypothermic cardioplegic infusion at pressures between 10 and 20 cm H2O.
为延长供体心脏移植的最长保存时间，有人主张持续低温低流量灌注心脏停搏液或其他保存液。我们报告了在持续灌注圣托马斯医院心脏停搏液过程中改变压力对长期保存后功能恢复的影响。将离体工作的大鼠心脏（每组6个）进行有氧灌注（20分钟），并测量心脏功能的对照指标；然后通过灌注3分钟（60厘米水柱）冷（7.5摄氏度）的圣托马斯医院心脏停搏液诱导低温缺血性停搏。然后将心脏在7.5摄氏度下保存8小时，要么浸泡在圣托马斯医院心脏停搏液中（非灌注对照），要么用已充氧并添加葡萄糖（11.1毫摩尔/升）的圣托马斯医院心脏停搏液以不同的灌注压力进行持续灌注。低温缺血8小时后，测量心脏停搏液的灌注速率作为血管阻力的指标。然后将心脏进行30分钟的再灌注（Langendorff灌注），在此期间测量肌酸激酶泄漏情况。然后将心脏转换为工作状态20分钟，测量收缩功能的恢复情况，并表示为缺血前对照值的百分比。在分别以6、10、20、30、40和60厘米水柱进行持续灌注的心脏中，主动脉流量的恢复率分别为0%（p<0.05）、38.6%±5.1%（p<0.05）、36.2%±3.6%（p<0.05）、14.0%±8.0%、5.8%±2.9%和9.9%±4.7%，缺血后肌酸激酶的泄漏量分别为98.7±19.5（p<0.05）、26.2±4.2、15.5±3.4、30.4±11.1、109.8±及136.0±14.1（p<0.05）国际单位/30分钟/克干重。相比之下，在非灌注对照心脏中，主动脉流量的恢复率为11.1%±7.5%，肌酸激酶泄漏量为58.9±8.7国际单位/30分钟/克干重。总之，在10至20厘米水柱的压力下进行持续低流量低温心脏停搏液灌注可实现最大程度的心肌保存。
