Aziz S, Tada Y, Jaffery S, Mori Y, Reichenbach D D, Gronka R, Kushmerick M, Verrier E D
Department of Surgery, University of Washington Medical Center, Seattle 98195.
J Heart Lung Transplant. 1994 Nov-Dec;13(6):1099-108.
The efficacy of the University of Wisconsin solution to safely prolong preservation times for kidney, pancreas, and liver transplantation is established, but its efficacy in enhancing myocardial preservation is not yet clear. We studied the effects of Stanford cardioplegic solution and the University of Wisconsin solution both in preserving the myocardium and in protecting it from the effects of reperfusion injury after 6 hours of preservation. In 28 rat hearts we measured changes in high-energy phosphate content (with magnetic resonance spectroscopy) and histologic changes (edema, endothelial changes, myocyte architecture) during preservation and changes in high-energy phosphate content, histologic status, and performance (aortic systolic and diastolic pressure, heart rate, rhythm) in Langendorff and working hearts during reperfusion. No significant differences in the kinetics of high-energy phosphate changes were noted between the two cardioplegic solutions during preservation. However, at the end of 6 hours of preservation, hearts in the Stanford cardioplegic solution group were more edematous (p < 0.01) than those in the University of Wisconsin group. During reperfusion, no significant differences in the kinetics of high-energy phosphates were noted between the two cardioplegic solutions. None of the hearts in the University of Wisconsin solution group developed ventricular fibrillation at the start of reperfusion, but all hearts in the Stanford group did so. Once sinus rhythm was established no significant differences in developed pressure or heart rate were found between the two solutions. After 2.5 hours of reperfusion, hearts in the Stanford group were more edematous (p < 0.002) and had a greater disruption of myocyte architecture (p < 0.002) and greater arteriolar endothelial injury (p < 0.004). In conclusion, the University of Wisconsin solution better protects the myocardium in this rat model than does Stanford solution. The mechanism for this beneficial effect of the University of Wisconsin solution appears to be due to its better preservation of the microvasculature rather than differences in preservation of high-energy phosphates.
威斯康星大学溶液在安全延长肾、胰腺和肝移植保存时间方面的有效性已得到证实，但其在增强心肌保存方面的有效性尚不清楚。我们研究了斯坦福心脏停搏液和威斯康星大学溶液在保存心肌以及保护其免受6小时保存后的再灌注损伤影响方面的作用。在28只大鼠心脏中，我们测量了保存期间高能磷酸盐含量的变化（通过磁共振波谱法）和组织学变化（水肿、内皮变化、心肌细胞结构），以及再灌注期间Langendorff心脏和工作心脏中高能磷酸盐含量、组织学状态和性能（主动脉收缩压和舒张压、心率、节律）的变化。在保存期间，两种心脏停搏液之间高能磷酸盐变化的动力学没有显著差异。然而，在保存6小时结束时，斯坦福心脏停搏液组的心脏比威斯康星大学组的心脏水肿更严重（p < 0.01）。在再灌注期间，两种心脏停搏液之间高能磷酸盐的动力学没有显著差异。威斯康星大学溶液组的心脏在再灌注开始时均未发生心室颤动，但斯坦福组的所有心脏均发生了心室颤动。一旦建立窦性心律，两种溶液之间在发育压力或心率方面没有发现显著差异。再灌注2.5小时后，斯坦福组的心脏水肿更严重（p < 0.002），心肌细胞结构破坏更大（p < 0.002），小动脉内皮损伤更严重（p < 0.004）。总之，在这个大鼠模型中，威斯康星大学溶液比斯坦福溶液能更好地保护心肌。威斯康星大学溶液这种有益作用的机制似乎是由于其对微血管的更好保存，而不是高能磷酸盐保存方面的差异。
