Segel L D, Follette D M, Iguidbashian J P, Contino J P, Castellanos L M, Berkoff H A, Kaufman R J, Schweighardt F K
Department of Surgery, University of California School of Medicine, Davis 95616.
J Heart Lung Transplant. 1994 Jul-Aug;13(4):669-80.
This study was designed to determine whether the novel perfluoroperhydrophenanthrene-egg yolk phospholipid emulsion, APE-LM, was an effective oxygen carrier for long-term hypothermic heart preservation. We postulated that hearts preserved with APE-LM would be well oxygenated during 24-hour preservation and that reperfusion of such hearts with blood would not produce functional or metabolic evidence of myocardial ischemia. Four groups of rabbit hearts were studied (n = 7 per group): fresh controls: nonpreserved, nontransplanted hearts; surgical controls: fresh hearts transplanted heterotopically for 75 minutes before explant and study for 4 hours as isolated working hearts perfused at 37 degrees C; crystalloid-preserved: hearts preserved with crystalloid medium, followed by transplantation and isolated heart perfusion; APE-LM-preserved: hearts treated as those in the crystalloid-preserved group, but preservation was with medium containing APE-LM emulsion (10 ml/dl). Preservation was with continuous coronary perfusion at 18 mm Hg pressure, 12 degrees C, and oxygen tension 838 +/- 11 mm Hg. During preservation, APE-LM hearts had significantly higher pyruvate consumption, and correspondingly higher oxygen consumption, than that of crystalloid hearts. No significant differences were found among fresh controls, surgical controls, and APE-LM-preserved hearts with respect to contractile or output function, oxygen consumption and efficiency indexes, or lactate production during in vitro perfusion. Left ventricular peak systolic pressure and peak rate of pressure development were significantly lower for crystalloid-preserved hearts than for fresh and surgical controls. Left ventricular end-diastolic pressure of crystalloid-preserved hearts was higher than that of the other three groups. The data indicate that rabbit hearts in this model were well preserved with APE-LM and that this emulsion produced better recovery of function than did crystalloid preservation, possibly as a consequence of the high oxygen delivery by the fluorocarbon during preservation.
本研究旨在确定新型全氟全氢菲 - 蛋黄磷脂乳剂APE - LM是否为长期低温心脏保存的有效氧载体。我们推测，用APE - LM保存的心脏在24小时保存期间将得到良好的氧合，并且用血液对这些心脏进行再灌注不会产生心肌缺血的功能或代谢证据。研究了四组兔心脏（每组n = 7）：新鲜对照组：未保存、未移植的心脏；手术对照组：新鲜心脏异位移植75分钟，然后取出并作为离体工作心脏在37℃灌注4小时进行研究；晶体液保存组：用晶体液培养基保存心脏，随后进行移植和离体心脏灌注；APE - LM保存组：心脏处理方式与晶体液保存组相同，但用含APE - LM乳剂（10 ml/dl）的培养基保存。在18 mmHg压力、12℃和氧分压838±11 mmHg下进行连续冠状动脉灌注保存。在保存期间，APE - LM保存的心脏比晶体液保存的心脏丙酮酸消耗显著更高，相应地氧消耗也更高。在新鲜对照组、手术对照组和APE - LM保存的心脏之间，关于体外灌注期间的收缩或输出功能、氧消耗和效率指标或乳酸产生，未发现显著差异。晶体液保存的心脏左心室收缩压峰值和压力上升峰值速率显著低于新鲜和手术对照组。晶体液保存的心脏左心室舒张末期压力高于其他三组。数据表明，该模型中的兔心脏用APE - LM保存良好，并且这种乳剂比晶体液保存产生了更好的功能恢复，这可能是由于保存期间氟碳化合物的高氧输送所致。
