Billingham M E, Baumgartner W A, Watson D C, Reitz B A, Masek M A, Raney A A, Oyer P E, Stinson E B, Shumway N E
Circulation. 1980 Aug;62(2 Pt 2):I11-9.
The paucity of donor hearts for human transplantation can be remedied by distant heart procurement. In the present study, 12 donor hearts obtained at distant locatins were preserved by infusion with 500 ml of cardioplegic solution at 4 degrees C at 150 mm Hg and immersion in 4 degrees C saline for rapid transmural cooling. They were transported in ice-cold saline. Maximal ischemic times were 110-182 minutes. Septal biopsies before coronary reperfusion showed normal mitochondria (11 and 12), normal nuclei (seven of 12), myofibrillar I-bands (six of 12), and capillary endothelial swelling (12 of 12). Septal biopsies 30 minutes after reperfusion showed mitochondrial swelling (six of 10), nuclear damage (10 of 10), myofibrillar contraction (10 of 10), and endothelial swelling (eight of 10). All grafts functioned satisfactorily. Eight of the 12 patients were alive 6-15 months later; four patients died (one of pulmonary hypertension and three of infection). We concluded that (1) human hearts show significant ultrastructural changes after 3 hours of ischemia, but (2) these worsen after reperfusion, and (3) distant heart procurement is feasible for human transplantation.
通过远距离获取心脏可弥补人体移植供心的短缺。在本研究中，从远处获取的12颗供心，通过在4℃、150mmHg压力下灌注500ml心脏停搏液并浸泡于4℃盐水中进行快速透壁冷却来保存。它们被置于冰冷盐水中运输。最大缺血时间为110 - 182分钟。冠状动脉再灌注前的间隔组织活检显示线粒体正常（11例和12例）、细胞核正常（12例中的7例）、肌原纤维I带正常（12例中的6例）以及毛细血管内皮肿胀（12例均有）。再灌注30分钟后的间隔组织活检显示线粒体肿胀（10例中的6例）、核损伤（10例均有）、肌原纤维收缩（10例均有）以及内皮肿胀（10例中的8例）。所有移植物功能均良好。12例患者中有8例在6 - 15个月后存活；4例患者死亡（1例死于肺动脉高压，3例死于感染）。我们得出结论：（1）人体心脏在缺血3小时后显示出显著的超微结构变化，但（2）这些变化在再灌注后会恶化，并且（3）远距离获取心脏用于人体移植是可行的。
