Kaliyev Rymbay, Lesbekov Timur, Bekbossynov Serik, Bekbossynova Makhabbat, Nurmykhametova Zhuldyz, Novikova Svetlana, Smagulov Nurlan, Medressova Assel, Faizov Linar, Ashyrov Zhanibek, la Fleur Philip, Samalavicius Robertas, Pya Yuriy
National Research Center for Cardiac Surgery, Astana, Kazakhstan.
Nazarbayev University School of Medicine, Astana, Kazakhstan.
J Card Surg. 2019 Oct;34(10):969-975. doi: 10.1111/jocs.14162. Epub 2019 Jul 23.
Cold crystalloid cardioplegia for donor heart harvesting and cold ischemic storage conditions during the transportation is the standard of care during heart transplantation procedure. Organ care system (OCS) was introduced for more prolonged and reliable ex vivo organ management. This study evaluated the two different techniques used for myocardial preservation during the procurement and transportation of the heart using the OCS.
We performed prospective analysis of 43 patients with heart failure undergoing heart transplantation and using the OCS for donor organ transport. Donor hearts were arrested using blood cardioplegia and conditioning (n = 30) or standard Custodiol (SC) solution ( n = 13). Perfusion and cardiac function parameters were continuously monitored while the donor hearts were perfused in the OCS. Impact of preservation techniques on biochemical parameters and clinical outcomes were evaluated.
All donor hearts had stable perfusion and lactate characteristics in the OCS, with similar measures between the two groups at the beginning of the ex vivo perfusion. Ex vivo heart perfusion mean ending concentration of Interleukin (IL)-6 and IL-8 was significantly lower in the blood cardioplegia group compared to the standard care group. Clinical outcomes were comparable between the two groups of patients.
The use of blood cardioplegia and conditioning could be a safe method for myocardial protection in distant procurement and preservation of donor hearts in the OCS.
在心脏移植手术中，用于获取供体心脏的冷晶体心脏停搏液以及运输过程中的冷缺血保存条件是标准的护理措施。器官护理系统（OCS）被引入用于更长期且可靠的离体器官管理。本研究评估了在使用OCS进行心脏获取和运输过程中用于心肌保护的两种不同技术。
我们对43例接受心脏移植且使用OCS进行供体器官运输的心力衰竭患者进行了前瞻性分析。供体心脏使用血液心脏停搏液和预处理（n = 30）或标准Custodiol（SC）溶液（n = 13）进行停搏。在OCS中对供体心脏进行灌注时，持续监测灌注和心脏功能参数。评估保存技术对生化参数和临床结果的影响。
所有供体心脏在OCS中均具有稳定的灌注和乳酸特征，在离体灌注开始时两组之间的测量值相似。与标准护理组相比，血液心脏停搏液组的离体心脏灌注白细胞介素（IL）-6和IL-8的平均终末浓度显著更低。两组患者的临床结果相当。
在OCS中远距离获取和保存供体心脏时，使用血液心脏停搏液和预处理可能是一种安全的心肌保护方法。
