持续灌注可改善供体大鼠心脏的保存：植入阶段的重要性。

Nickless D K, Rabinov M, Richards S M, Conyers R A, Rosenfeldt F L

Baker Medical Research Institute, Melbourne, Australia.

Ann Thorac Surg. 1998 May;65(5):1265-72. doi: 10.1016/s0003-4975(98)00172-6.

BACKGROUND

Continuous hypothermic perfusion of donor hearts may provide extra protection for long ischemic times and suboptimal donors. The aim of three separate studies was to assess the effect of continuous hypothermic perfusion during simulated donor heart storage and implantation.

METHODS

In study 1 twelve isolated rat hearts underwent 10 minutes of normothermic ischemia to simulate the effect of brain death on the heart and 5 hours of cardioplegic arrest, using University of Wisconsin solution. Six hearts were statically stored in University of Wisconsin solution at 2 degrees C, and six were perfused with University of Wisconsin solution. To assess the effect of simulated implantation, in study 2 an additional 12 hearts were statically stored for 5.5 hours in University of Wisconsin solution, six of which were rewarmed to a mean of 16 degrees C over the last 30 minutes of arrest. To assess the effect of simulated perfusion, in study 3 during implantation 12 hearts were rewarmed to a mean of 16 degrees C over the last 30 minutes of arrest, during which time six were perfused with 2 degrees C solution.

RESULTS

Hearts perfused during storage demonstrated greater recovery of prearrest power, 85.8% +/- 1.8%, than hearts preserved by static storage, 72.7% +/- 3.0% (p < 0.01). The simulated warm implantation period reduced recovery of power from 68.3% +/- 5.1% to 40.2% +/- 2.0% (p < 0.001). Perfusion during warm implantation improved recovery to 61.8% +/- 3.9% (p < 0.01). In all experiments improved function was accompanied by improved metabolic energy status.

CONCLUSIONS

During the implantation period of heart transplantation the donor heart sustains injury that could amount to 50% of total ischemic injury. Continuous perfusion during the cold storage phase and during simulated implantation improves recovery of the donor heart.

背景

对供体心脏进行持续低温灌注可为长缺血时间和非理想供体提供额外保护。三项独立研究的目的是评估模拟供体心脏保存和植入过程中持续低温灌注的效果。

方法

在研究1中，12个离体大鼠心脏经历10分钟常温缺血以模拟脑死亡对心脏的影响，然后使用威斯康星大学溶液进行5小时心脏停搏。6个心脏在2℃的威斯康星大学溶液中静态保存，6个心脏用威斯康星大学溶液进行灌注。为评估模拟植入的效果，在研究2中，另外12个心脏在威斯康星大学溶液中静态保存5.5小时，其中6个在停搏的最后30分钟内复温至平均16℃。为评估模拟灌注的效果，在研究3中，12个心脏在停搏的最后30分钟内复温至平均16℃，在此期间，6个心脏用2℃溶液进行灌注。

结果

保存期间进行灌注的心脏，停搏前功率的恢复率为85.8%±1.8%，高于静态保存的心脏，后者为72.7%±3.0%（p<0.01）。模拟的温暖植入期使功率恢复率从68.3%±5.1%降至40.2%±2.0%（p<0.001）。温暖植入期进行灌注可使恢复率提高至61.8%±3.9%（p<0.01）。在所有实验中，功能改善伴随着代谢能量状态的改善。