Budrikis A, Bolys R, Liao Q, Ingemansson R, Sjöberg T, Steen S
Department of Cardiothoracic Surgery, University Hospital of Lund, Sweden.
Ann Thorac Surg. 1998 Jul;66(1):73-8. doi: 10.1016/s0003-4975(98)00316-6.
Most cardioplegic solutions have been developed using the classic Langendorf heart perfusion model, which only allows a short experimental follow-up. Our aim was to investigate hearts after prolonged storage by using a physiologic model including prolonged perfusion with normal, fresh blood.
Sixteen hearts from 60-kg pigs were preserved with dextran-enriched (dextran-40, 35 g/L) St. Thomas' solution for 2 or 12 hours after which they were continuously reperfused for 12 hours with normal blood, supplied by a support pig. A flexible balloon, fixed to an artificial valve apparatus connected to a circuit system, was inserted in the left ventricle for obtaining measurements of hemodynamic performance.
During the first 3 to 4 hours of reperfusion there was no significant difference in left ventricular developed pressure, cardiac output, minute work output, or oxygen consumption between the two groups. After this time left ventricular developed pressure (p < 0.001), cardiac output (p < 0.01), minute work output (p < 0.01), and oxygen consumption were significantly lower in the 12-hour group. Coronary flow was higher (p < 0.01) and coronary vascular resistance lower (p < 0.01) during the first 5 to 6 hours of reperfusion in the 12-hour group. After 12 hours of reperfusion coronary vascular resistance was significantly higher (p < 0.01) in the 12-hour group.
High-degree and long-lasting coronary hyperemia at the beginning of reperfusion can be a sign of unsatisfactory preservation of the heart. This investigation shows the importance of reperfusion with normal blood and a long follow-up period after postischemic reperfusion when studying the effect of cardioplegic solutions.
大多数心脏停搏液是使用经典的Langendorf心脏灌注模型研发的，该模型仅允许进行短期的实验随访。我们的目的是通过使用一种生理模型来研究长时间保存后的心脏，该模型包括用正常新鲜血液进行长时间灌注。
取16颗来自60千克猪的心脏，用富含右旋糖酐（右旋糖酐-40，35克/升）的圣托马斯溶液保存2或12小时，之后由供体猪提供正常血液对其进行12小时的持续再灌注。将一个柔性球囊固定在连接到循环系统的人工瓣膜装置上，插入左心室以测量血流动力学性能。
在再灌注的最初3至4小时内，两组之间的左心室舒张末压、心输出量、每分钟功输出或氧耗量没有显著差异。在此之后，12小时组的左心室舒张末压（p<0.001）、心输出量（p<0.01）、每分钟功输出（p<0.01）和氧耗量显著降低。在12小时组再灌注的最初5至6小时内，冠状动脉血流量较高（p<0.01），冠状动脉血管阻力较低（p<0.01）。再灌注12小时后，12小时组的冠状动脉血管阻力显著更高（p<0.01）。
再灌注开始时的高度和持久的冠状动脉充血可能是心脏保存不佳的迹象。这项研究表明，在研究心脏停搏液的效果时，用正常血液进行再灌注以及缺血后再灌注后的长时间随访很重要。
