A comparison of the University of Wisconsin solution and the modified Kawakami solution for initial flush and coronary perfusion in long-term canine heart preservation.

BACKGROUND

We compared two different solutions, the University of Wisconsin (UW) solution (intracellular-like) and the modified Kawakami (mK) solution (extracellular-like), for initial flush of coronary vascular beds before simple storage and following coronary perfusion.

METHODS

After a right thoracotomy in the 4th intercostal space, the donor heart was isolated by ligating the azygos vein and venae cavae, and cross-clamping the aorta. Cardiac arrest was then obtained with a cold GIK solution. Following initial flush of coronary vascular beds, the donor heart was resected, stored utilizing a combination of simple immersion and coronary perfusion, and then transplanted. A total of 48 mongrel dogs was divided into three groups each using different solutions for the initial flush of coronary vascular beds and for coronary perfusion. In group I (n=10) the UW solution was used for both initial flush and coronary perfusion. In group II (n=7) the mK solution was used for both initial flush and coronary perfusion, and in group III (n=7) the UW solution was used for initial flush and the mK solution for coronary perfusion. Intracellular high-energy phosphate was surveyed by 31P-nuclear magnetic resonance spectroscopy.

RESULTS

After 12-hour simple immersion and 1-hour coronary perfusion, phosphocreatine and adenosine triphosphate were significantly (p<0.05) higher in group III than in groups I and II. The high-energy phosphate levels of the graft tissue were better in groups I and III than in group II. Orthotopic transplantation was then performed using 10 preserved grafts in group I and seven preserved grafts of group III. After transplantation, left ventricular (LV) pressure of group I animals recovered to 82.3% and group III recovered to 95.8% of the control values. LV dp/dt of group I and III animals recovered to 76.5% and 96.7% of the control values, respectively.

CONCLUSIONS

The UW solution, which is acceptable for both initial flush and simple storage, is not suitable for continuous coronary perfusion even for a short period due to its high viscosity. A combination of the UW solution both for initial flush and the following cold simple immersion and the mK solution for continuous coronary perfusion is appropriate for long-term preservation of the canine heart.