Hirota Masanori, Ishino Kozo, Fukumasu Ichiro, Yoshida Kazuhiro, Mohri Satoshi, Shimizu Juichiro, Kajiya Fumihiko, Sano Shunji
Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan.
J Heart Lung Transplant. 2006 Mar;25(3):339-44. doi: 10.1016/j.healun.2005.09.014. Epub 2006 Jan 25.
Cardiac function of non-heart-beating donors (NHBDs) is uncertain due to severe myocardial damage. We developed an isolated myocardial perfusion system to resuscitate NHBD hearts and attempted to predict functional recovery of 60-minute warm ischemic hearts by analyzing systolic and diastolic functions.
Hypoxic cardiac arrest was induced in 8 mongrel dogs without any pre-treatments. After 60-minute ischemia, intracoronary microthrombi were flushed out by retrograde blood cardiopledia with tissue-type plasminogen activator. Coronary arteries were initially perfused from the aortic root with tepid hyperkalemic blood (20 mmol/liter) at low pressure (20 mm Hg) for the first 60 minutes and then with normothermic blood for the next 60 minutes. After 120 minutes of reperfusion, pre-load was increased for ejection against an after-load of 80 mm Hg. Pressure-volume loops were recorded to obtain the end-systolic pressure-volume relationship (ESPVR) and end-diastolic pressure-volume relationship (EDPVR). Stroke volume at a given pre-load was calculated from averaged ESPVR, EDPVR and after-load identical to an averaged baseline value. The Frank-Starling relationship was obtained and cardiac status was classified according to Forrester's hemodynamic sub-set.
End-systolic elastance decreased significantly to about 60% of baseline and the time constant of isovolumic relaxation was prolonged significantly by about 20%. Cardiac index was decreased to about 50% and cardiac status was classified in the Forrester III or IV sub-set.
The extent of functional recovery of NHBD hearts is predictable by cardiac output. Although 120 minutes of recovery time may be short for 60-minute ischemic damage, this system may be feasible to predict post-transplant cardiac function before transplantation.
由于严重的心肌损伤，非心脏跳动供体（NHBDs）的心脏功能尚不确定。我们开发了一种离体心肌灌注系统来复苏NHBD心脏，并试图通过分析收缩和舒张功能来预测60分钟热缺血心脏的功能恢复情况。
对8只杂种犬不进行任何预处理，诱导其发生缺氧性心脏骤停。缺血60分钟后，用组织型纤溶酶原激活剂通过逆行血液心脏停搏液冲洗冠状动脉内微血栓。冠状动脉最初在低压（20 mmHg）下从主动脉根部用温热高钾血液（20 mmol/L）灌注60分钟，然后用常温血液灌注接下来的60分钟。再灌注120分钟后，增加前负荷以在80 mmHg的后负荷下射血。记录压力-容积环以获得收缩末期压力-容积关系（ESPVR）和舒张末期压力-容积关系（EDPVR）。根据平均ESPVR、EDPVR和与平均基线值相同的后负荷计算给定前负荷下的每搏输出量。获得Frank-Starling关系，并根据Forrester血流动力学亚组对心脏状态进行分类。
收缩末期弹性显著降低至基线的约60%，等容舒张时间常数显著延长约20%。心脏指数降至约50%，心脏状态被分类为Forrester III或IV亚组。
NHBD心脏的功能恢复程度可通过心输出量预测。尽管对于60分钟的缺血损伤，120分钟的恢复时间可能较短，但该系统在移植前预测移植后心脏功能方面可能是可行的。
