采用单纯浸泡与冠状动脉灌注联合方法进行心脏长期保存。

Long-term heart preservation by the combined method of simple immersion and coronary perfusion.

作者信息

Ohtaki A, Ogiwara H, Sakata K, Takahashi T, Morishita Y

机构信息

Second Department of Surgery, Gunma University School of Medicine, Japan.

出版信息

J Heart Lung Transplant. 1996 Mar;15(3):269-74.

PMID:8777210

Abstract

BACKGROUND

The combined method of cold storage and coronary perfusion for prolonged preservation of donor hearts was evaluated through preservation and transplantation with the use of 10 pair of adult mongrel dogs.

METHODS

In situ initial flush for cooling and coronary vascular washout was performed with a University of Wisconsin solution. The heart was then removed and immersed into a cold (4degrees C) University of Wisconsin solution. After 12-hour cold storage, 1-hour preservation was added by coronary perfusion using a 4degree C oxygenated University of Wisconsin solution. High-energy phosphate (phosphocreatine, beta-adenosine triphosphate) and phosphate were measured by 31P-nuclear magnetic resonance spectroscopy at 0-hour cold storage, 12-hour cold storage, and immediately after coronary perfusion.

RESULTS

Phosphocreatine and beta-adenosine triphosphate decreased to 12.1 +/- 24.2% (mean +/ standard deviation), 37.4% +/- 25.0%, respectively, after 12-hour cold storage, and significantly increased to 94.0% +/- 48.7% (p < 0.001), 48.8% (p < 0.05), respectively after 1-hour coronary perfusion. Disorder of nuclear arrangement and edema of muscular cells, which were observed after cold storage, were histologically restored after 1-hour coronary perfusion. After transplantation of preserved grafts, left ventricular pressure and left ventricular rate of pressure rise were evaluated in the graft with 12-hour cold storage only (group A) and in the graft with 12-hour cold storage and 1-hour coronary perfusion (group B). Left ventricular pressure 2 hours after transplantation in group B recovered to 76.1% significantly (p < 0.01), compared with 51.9% in group A. Significantly higher values of left ventricular rate of pressure rise 2 hours after transplantation was observed in group B (83.0% +/ 12.7%) compared with group A (68.2% +/- 12.5%).

CONCLUSIONS

These results indicate that the combined method of cold storage and coronary perfusion may be effective for myocardial protection during long-term preservation.

摘要

背景

通过对10对成年杂种犬进行心脏保存和移植，评估了冷藏与冠状动脉灌注相结合的方法对供心的长期保存效果。

方法

用威斯康星大学溶液进行原位初始冲洗以降温并冲洗冠状动脉血管。然后取出心脏，浸入冷（4℃）的威斯康星大学溶液中。冷藏12小时后，用4℃的氧合威斯康星大学溶液进行冠状动脉灌注，再保存1小时。在冷藏0小时、12小时以及冠状动脉灌注后立即用31P-核磁共振波谱法测量高能磷酸（磷酸肌酸、β-三磷酸腺苷）和磷酸盐。

结果

冷藏12小时后，磷酸肌酸和β-三磷酸腺苷分别降至12.1%±24.2%（平均值±标准差）、37.4%±25.0%，冠状动脉灌注1小时后分别显著升至94.0%±48.7%（p<0.001）、48.8%（p<0.05）。冷藏后观察到的细胞核排列紊乱和肌细胞水肿在冠状动脉灌注1小时后组织学上得到恢复。在移植保存的移植物后，仅对冷藏12小时的移植物（A组）和冷藏12小时并冠状动脉灌注1小时的移植物（B组）评估左心室压力和左心室压力上升速率。与A组的51.9%相比，B组移植后2小时的左心室压力显著恢复至76.1%（p<0.01）。移植后2小时，B组（83.0%±12.7%）的左心室压力上升速率值显著高于A组（68.2%±12.5%）。