Kontos G J, Adachi H, Borkon M A, Cameron D E, Baumgartner W A, Hutchins G M, Brawn J, Reitz B A
Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, MD 21205.
J Thorac Cardiovasc Surg. 1987 Dec;94(6):836-42.
In order to determine whether a no-flush, core-cooling technique could provide extended heart-lung preservation, we placed donor calves on cardiopulmonary bypass and instituted rapid cooling to 15 degrees C during the continuous infusion of isoproterenol. The heart and lungs were harvested after the administration of a cardioplegic solution through the aortic root. In the control group (N = 5), heart and lungs were orthotopically allotransplanted immediately. In the preserved group (N = 5), heart and lungs were similarly excised but were stored in a normal saline bath at 4 degrees C for approximately 4 hours and then transplanted. Both groups received isoproterenol during reperfusion and were studied for 6 hours after implantation. A load independent analysis of myocardial function was done by determining with a sonomicrometer the ratio of the end-systolic pressure to the end-systolic dimension. Pulmonary preservation was evaluated by measurement of extravascular lung water with a double-indicator dilution method, arterial oxygenation on 100% inspired oxygen, and serial lung biopsies. Myocardial and pulmonary function after 4 hours of static preservation was found to be similar to controls. No-flush, core-cooling with cardiopulmonary bypass provides adequate cardiorespiratory function after acute bovine heart-lung allotransplantation. With the use of this technique, successful extended cold ischemic cardiopulmonary preservation for heart-lung transplantation may be achieved.
为了确定无冲洗、核心冷却技术是否能提供延长的心肺保存时间，我们将供体小牛置于体外循环下，并在持续输注异丙肾上腺素期间迅速冷却至15摄氏度。通过主动脉根部给予心脏停搏液后，摘取心脏和肺脏。在对照组（N = 5）中，心脏和肺脏立即进行原位同种异体移植。在保存组（N = 5）中，心脏和肺脏同样被切除，但在4摄氏度的生理盐水浴中保存约4小时，然后进行移植。两组在再灌注期间均接受异丙肾上腺素治疗，并在植入后研究6小时。通过用超声微测仪测定收缩末期压力与收缩末期直径的比值，对心肌功能进行负荷独立分析。通过双指示剂稀释法测量血管外肺水、吸入100%氧气时的动脉氧合以及连续肺活检来评估肺保存情况。发现静态保存4小时后的心肌和肺功能与对照组相似。体外循环下的无冲洗、核心冷却在急性牛心肺同种异体移植后可提供足够的心肺功能。使用该技术，可能实现心肺移植成功的延长冷缺血心肺保存。
