Minasian Sarkis M, Galagudza Michael M, Dmitriev Yuri V, Karpov Andrey A, Vlasov Timur D
Institute of Experimental Medicine, Federal Almazov Medical Research Centre, St Petersburg, Russian Federation Department of Pathophysiology, First Pavlov State Medical University of St Petersburg, St Petersburg, Russian Federation.
Institute of Experimental Medicine, Federal Almazov Medical Research Centre, St Petersburg, Russian Federation Department of Pathophysiology, First Pavlov State Medical University of St Petersburg, St Petersburg, Russian Federation
Interact Cardiovasc Thorac Surg. 2015 Apr;20(4):510-9. doi: 10.1093/icvts/ivu432. Epub 2014 Dec 23.
The methods of donor heart preservation are aimed at minimizing graft dysfunction caused by ischaemia-reperfusion injury (IRI) which inevitably occurs during the ex vivo transport interval. At present, the standard technique of heart preservation is cardiac arrest followed by static cold storage in a crystalloid heart preservation solution (HPS). This technique ensures an acceptable level of heart protection against IRI for <6 h. In clinical trials, comparable levels of myocardial protection against IRI were provided by various HPSs. The growing shortage of donor hearts is one of the major factors stimulating the development of new techniques of heart preservation. Here, we summarize new HPS formulations and provide a focus for optimization of the composition of existing HPSs. Such methods of donor heart preservation as machine perfusion, preservation at sub-zero temperature and oxygen persufflation are also discussed. Furthermore, we review experimental data showing that pre- and post-conditioning of the cardiac graft can improve its function when used in combination with cold storage. The evidence on the feasibility of cardiac donation after circulatory death, as well as the techniques of heart reconditioning after a period of warm ischaemia, is presented. The implementation of new techniques of donor heart preservation may contribute to the use of hearts from extended criteria donors, thereby expanding the total donor pool.
供心保存方法旨在尽量减少缺血再灌注损伤（IRI）导致的移植物功能障碍，这种损伤在体外运输期间不可避免地会发生。目前，心脏保存的标准技术是心脏停搏，随后在晶体心脏保存液（HPS）中进行静态冷藏。该技术可确保在<6小时内对心脏提供可接受水平的IRI保护。在临床试验中，各种HPS对IRI提供了相当水平的心肌保护。供心日益短缺是刺激新的心脏保存技术发展的主要因素之一。在此，我们总结了新的HPS配方，并重点关注现有HPS成分的优化。还讨论了诸如机器灌注、零下温度保存和氧气吹入等供心保存方法。此外，我们回顾了实验数据，这些数据表明心脏移植物的预处理和后处理与冷藏联合使用时可改善其功能。介绍了循环死亡后心脏捐献可行性的证据，以及一段时间的热缺血后心脏修复技术。供心保存新技术的实施可能有助于使用扩大标准供体的心脏，并从而扩大整个供体库。
