Brant S M, Rosenbaum D H, Cobert M L, West L M, Jessen M E, Peltz M
Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
Transplant Proc. 2014 Jun;46(5):1601-5. doi: 10.1016/j.transproceed.2014.03.006.
Most studies investigating machine perfusion preservation for heart transplantation perfuse through the aortic root (antegrade), but the coronary sinus (retrograde) is a potential option. We hypothesized that retrograde machine perfusion provides better functional protection than static storage, while avoiding the potential irregular perfusion seen when aortic insufficiency occurs with antegrade perfusion.
Eighteen canine donor hearts were arrested, procured, and stored in modified Celsior solution for 4 hours by using either static storage at 0°C to 4°C (n = 6) or machine perfusion preservation at 5°C via the aortic root (antegrade, n = 6) or coronary sinus (retrograde, n = 6). Lactate and myocardial oxygen consumption were measured in perfused hearts. Hearts were reimplanted and reperfused for 6 hours with hourly function calculated by using the preload recruitable stroke work (PRSW) relation. Myocardial water content was determined at the end of the experiment.
Storage lactate levels and myocardial oxygen consumption were comparable in both perfused groups. The PRSW was increased immediately after bypass in the antegrade group (120.6 ± 19.1 mm Hg) compared with the retrograde (75.0 ± 11.3 mm Hg) and static (78.1 ± 10.5 mm Hg) storage groups (P < .05). At the end of reperfusion, PRSW was higher in the retrograde group (69.8 ± 7.4 mm Hg) compared with the antegrade (40.1 ± 6.8 mm Hg) and static (39.9 ± 10.9 mm Hg) storage groups (P < .05). Myocardial water content was similar among groups.
Both antegrade and retrograde perfusion demonstrated excellent functional preservation, at least equivalent to static storage. Initial function was superior in the antegrade group, but the retrograde hearts displayed better function late after reperfusion. Neither perfused group developed significant edema. Machine perfusion preservation is a promising technique for improving results of cardiac transplantation.
大多数研究心脏移植机器灌注保存的实验都是通过主动脉根部进行顺行灌注，但冠状静脉窦逆行灌注也是一种可行的选择。我们假设逆行机器灌注比静态保存能提供更好的功能保护，同时避免顺行灌注出现主动脉瓣关闭不全时可能出现的不规则灌注。
18只犬供体心脏停跳后获取，置于改良Celsior溶液中，分别采用4℃静态保存4小时（n = 6）、5℃经主动脉根部顺行机器灌注保存（n = 6）或经冠状静脉窦逆行机器灌注保存（n = 6）。测量灌注心脏中的乳酸和心肌耗氧量。心脏再植入后再灌注6小时，每小时通过预负荷可募集搏功（PRSW）关系计算心脏功能。实验结束时测定心肌含水量。
两个灌注组的保存乳酸水平和心肌耗氧量相当。与逆行灌注组（75.0±11.3 mmHg）和静态保存组（78.1±10.5 mmHg）相比，顺行灌注组在体外循环后即刻PRSW升高（120.6±19.1 mmHg）（P < 0.05）。再灌注结束时，逆行灌注组的PRSW（69.8±7.4 mmHg）高于顺行灌注组（40.1±6.8 mmHg）和静态保存组（39.9±10.9 mmHg）（P < 0.05）。各组间心肌含水量相似。
顺行灌注和逆行灌注均显示出良好的功能保存，至少与静态保存相当。顺行灌注组的初始功能较好，但逆行灌注心脏在再灌注后期功能更佳。两个灌注组均未出现明显水肿。机器灌注保存是一种有望改善心脏移植结果的技术。
