Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Department of Regenerative Medicine Research, Texas Heart Institute, Houston, Tex.
Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
J Thorac Cardiovasc Surg. 2024 Apr;167(4):1346-1358. doi: 10.1016/j.jtcvs.2023.09.034. Epub 2023 Sep 22.
Single-dose del Nido solution was recently used in human donation after circulatory death (DCD) heart procurement. We compared the effect of del Nido cardioplegia on myocardial edema, inflammatory response, and injury in human DCD hearts and human donation after brain death (DBD) hearts with different warm ischemic times (WIT) and subsequent cold saline storage times (CST).
A total of 24 human hearts, including 6 in the DBD group and 18 in the DCD group-were procured for the research study. The DCD group was divided into 3 subgroups based on WIT: 20, 40, and ≥60 minutes. All hearts received 1 L of del Nido cardioplegia before being placed in cold saline for 6 hours. Left ventricular biopsies were performed at 0, 2, 4, and 6 hours. Temporal changes in myocardial edema, inflammatory cytokines (TNF-α, IL-6, and IL-1β), and histopathology injury scores were compared between the DBD and DCD groups.
DCD hearts showed more profound changes in myocardial edema, inflammation, and injury than DBD hearts at baseline and subsequent CST. The DCD heart with WIT of 20 and 40 minutes with CST of 4 and 2 hours, respectively, appeared to have limited myocardial edema, inflammation, and injury. DCD hearts with WIT ≥60 minutes showed severe myocardial edema, inflammation, and injury at baseline and subsequent CST.
Single-dose cold del Nido cardioplegia and subsequent cold normal saline storage can preserve both DCD and DBD hearts. DCD hearts have been shown to be able to tolerate a WIT of 20 minutes and subsequent CST of 4 hours without experiencing significant myocardial edema, inflammation, and injury.
单次剂量的 Del Nido 溶液最近被用于循环死亡后（DCD）供体心脏的获取。我们比较了 Del Nido 心脏停搏液对不同热缺血时间（WIT）和随后冷盐水储存时间（CST）的人类 DCD 心脏和脑死亡后捐赠（DBD）心脏的心肌水肿、炎症反应和损伤的影响。
共采集了 24 个人类心脏，包括 6 个 DBD 组和 18 个 DCD 组。DCD 组根据 WIT 分为 3 个亚组：20、40 和≥60 分钟。所有心脏在放入冷盐水中 6 小时前均接受 1L 的 Del Nido 心脏停搏液。在 0、2、4 和 6 小时时进行左心室活检。比较 DBD 和 DCD 组之间心肌水肿、炎症细胞因子（TNF-α、IL-6 和 IL-1β）和组织病理学损伤评分的时间变化。
与 DBD 心脏相比，基线时和随后的 CST 时，DCD 心脏的心肌水肿、炎症和损伤变化更为明显。分别具有 20 和 40 分钟 WIT 且 CST 分别为 4 和 2 小时的 DCD 心脏似乎具有有限的心肌水肿、炎症和损伤。WIT≥60 分钟的 DCD 心脏在基线和随后的 CST 时表现出严重的心肌水肿、炎症和损伤。
单次剂量冷 Del Nido 心脏停搏液和随后的冷生理盐水储存可以保存 DCD 和 DBD 心脏。DCD 心脏已被证明能够耐受 20 分钟的 WIT 和随后的 4 小时 CST，而不会发生明显的心肌水肿、炎症和损伤。
