Cardiac Sciences Program, University of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada; Institute of Cardiovascular Sciences, St. Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada.
Institute of Cardiovascular Sciences, St. Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada.
J Heart Lung Transplant. 2015 Jan;34(1):113-121. doi: 10.1016/j.healun.2014.09.021. Epub 2014 Sep 28.
Ex vivo heart perfusion (EVHP) provides the opportunity to resuscitate unused donor organs and facilitates assessments of myocardial function that are required to demonstrate organ viability before transplantation. We sought to evaluate the effect of different oxygen carriers on the preservation of myocardial function during EVHP.
Twenty-seven pig hearts were perfused ex vivo in a normothermic beating state for 6 hours and transitioned into working mode for assessments after 1 (T1), 3 (T3), and 5 (T5) hours. Hearts were allocated to 4 groups according to the perfusate composition. Red blood cell concentrate (RBC, n = 6), whole blood (RBC+Plasma, n = 6), an acellular hemoglobin-based oxygen carrier (HBOC, n = 8), or HBOC plus plasma (HBOC+Plasma, n = 7) were added to STEEN Solution (XVIVO Perfusion, Goteborg, Sweden) to achieve a perfusate hemoglobin concentration of 40 g/liter.
The perfusate composition affected the preservation of systolic (T5 dP/dtmax: RBC+Plasma = 903 ± 99, RBC = 771 ± 77, HBOC+Plasma = 691 ± 82, HBOC = 563 ± 52 mm Hg/sec; p = 0.047) and diastolic (T5 dP/dtmin: RBC+Plasma = -574 ± 48, RBC = -492 ± 63, HBOC+Plasma = -326 ± 32, HBOC = -268 ± 22 mm Hg/sec; p < 0.001) function, and the development of myocardial edema (weight gain: RBC+Plasma = 6.6 ± 0.9, RBC = 6.6 ± 1.2, HBOC+Plasma = 9.8 ± 1.7, HBOC = 16.3 ± 1.9 g/hour; p < 0.001) during EVHP. RBC+Plasma hearts exhibited less histologic evidence of myocyte damage (injury score: RBC+Plasma = 0.0 ± 0.0, RBC = 0.8 ± 0.3, HBOC+Plasma = 2.6 ± 0.2, HBOC = 1.75 ± 0.4; p < 0.001) and less troponin-I release (troponin-I fold-change T1-T5: RBC+Plasma = 7.0 ± 1.7, RBC = 13.1 ± 1.6, HBOC+Plasma = 20.5 ± 1.1, HBOC = 16.7 ± 5.8; p < 0.001). Oxidative stress was minimized by the addition of plasma to RBC and HBOC hearts (oxidized phosphatidylcholine compound fold-change T1-T5: RBC+Plasma = 1.83 ± 0.20 vs RBC = 2.31 ± 0.20, p < 0.001; HBOC+Plasma = 1.23 ± 0.17 vs HBOC = 2.80 ± 0.28, p < 0.001).
A whole blood-based perfusate (RBC+Plasma) minimizes injury and provides superior preservation of myocardial function during EVHP. The beneficial effect of plasma on the preservation of myocardial function requires further investigation.
体外心脏灌注（EVHP）提供了使未使用的供体器官复苏的机会，并促进了心肌功能评估，这是在移植前证明器官活力所必需的。我们试图评估不同的氧载体对 EVHP 期间心肌功能保存的影响。
27 只猪心在常温跳动状态下进行体外灌注 6 小时，并在 1 小时（T1）、3 小时（T3）和 5 小时（T5）后过渡到工作模式进行评估。根据灌注液成分将心脏分配到 4 组。红细胞浓缩物（RBC，n=6）、全血（RBC+血浆，n=6）、无细胞血红蛋白基氧载体（HBOC，n=8）或 HBOC+血浆（HBOC+血浆，n=7）添加到 STEEN 溶液（XVIVO 灌注，哥德堡，瑞典）中，使灌注液血红蛋白浓度达到 40 g/L。
灌注液成分影响收缩功能（T5 dP/dtmax：RBC+血浆=903±99，RBC=771±77，HBOC+血浆=691±82，HBOC=563±52mmHg/sec；p=0.047）和舒张功能（T5 dP/dtmin：RBC+血浆=-574±48，RBC=-492±63，HBOC+血浆=-326±32，HBOC=-268±22mmHg/sec；p<0.001），并在 EVHP 期间发展心肌水肿（体重增加：RBC+血浆=6.6±0.9，RBC=6.6±1.2，HBOC+血浆=9.8±1.7，HBOC=16.3±1.9g/hour；p<0.001）。RBC+血浆心脏表现出较少的肌细胞损伤组织学证据（损伤评分：RBC+血浆=0.0±0.0，RBC=0.8±0.3，HBOC+血浆=2.6±0.2，HBOC=1.75±0.4；p<0.001）和较少的肌钙蛋白 I 释放（肌钙蛋白 I 倍数变化 T1-T5：RBC+血浆=7.0±1.7，RBC=13.1±1.6，HBOC+血浆=20.5±1.1，HBOC=16.7±5.8；p<0.001）。通过向 RBC 和 HBOC 心脏添加血浆可以最小化氧化应激（氧化磷脂酰胆碱化合物倍数变化 T1-T5：RBC+血浆=1.83±0.20 与 RBC=2.31±0.20，p<0.001；HBOC+血浆=1.23±0.17 与 HBOC=2.80±0.28，p<0.001）。
基于全血的灌注液（RBC+血浆）可最大限度地减少损伤，并在 EVHP 期间提供更好的心肌功能保存。血浆对心肌功能保存的有益作用需要进一步研究。
