An autoperfused heart-lung-preparation: metabolism and function.

The number of heart transplantations performed in the United States is increasing, and better preservation techniques are needed for distant transport and improved organ viability. Earlier experiments demonstrated that the autoperfused heart-lung preparation maintains adequate function for six to seven hours without exogenous substrates or medications. The present study evaluated the metabolic alterations at normothermia in an autoperfused heart-lung preparation and if its longevity can be extended by satisfying metabolic requirements. Thirty autoperfused heart-lung preservations were tested with an elevated buffer-bag that maintained left ventricle pressure between 75 mm Hg and 80 mm Hg. The entry and exit ports of the buffer-bag were fitted with one-way valves to insure blood circulation. Left ventricle and arterial pressure, blood pH, PCO2, PO2, glucose, free fatty acids, pyruvate and lactate were measured at regular intervals. In a first series of experiments, myocardial biopsies were taken for ATP determinations. The autoperfused heart-lung preparations were found to consume preferentially free fatty acids until their arterial level dropped to 350 +/- 24 microEq/L. Glucose then became the perferred substrate. After six to seven hours, when the glucose level dropped to 10 mg/dL, the cardiac activity stopped. In a second series, a 10% glucose solution containing 25 IU/dL of insulin was infused at a rate of 0.1 mL/min, extending the longevity of the preparation up to 18 hours. Then, the heart dilated and abruptly stopped. Massive bacterial contamination was found. When aseptic techniques were used in conjunction with antibiotics, the longevity was extended to 24 hours.(ABSTRACT TRUNCATED AT 250 WORDS)