Fischer J H, Kuhn-Régnier F, Jeschkeit S, Switkowski R, Bardakcioglu O, Sobottke R, Rainer de Vivie E
Institute of Experimental Medicine, Department of Cardiothoracic Surgery, University of Cologne, Germany.
Transplantation. 1998 Dec 15;66(11):1450-9. doi: 10.1097/00007890-199812150-00007.
Improvement of heart preservation is still the greatest challenge in preservation research. The unchanged severe restriction of acceptable storage periods of heart grafts since the beginning of clinical heart transplantation indicates that technical innovations are necessary if a substantial improvement is to be achieved.
Here, we present the results of hypothermic preservation using the innovative technique of coronary oxygen persufflation (COP). COP simply adds gaseous oxygen to hypothermic graft storage and requires only a "valve guard" for reversible closure of the aortic valve. Fourteen-hr preservation was followed by orthotopic transplantation and evaluations of functional as well as metabolic recovery. Mature pig hearts, a model with restricted preservation tolerance similar to the human heart, were used to guarantee the clinical relevance of this study.
After 14-hr hypothermic storage, COP-preserved hearts were able to recover within 2 hr of cardiopulmonary bypass to a steady cardiovascular function without mechanical or pharmacologic support. The left ventricular pressure amplitude of mHTK-COP-preserved hearts as well as energy charge potential recovered to pregrafting values and the ventricular power output to 66%. Hearts simply stored in University of Wisconsin (UW), modified Bretschneider's histidine-tryptophan-ketoglurate (mHTK), or Euro-Flush with glutathione (EFG) solution had only limited recovery, with significantly lower ventricular power output of 18%, 29% or 30% of pregrafting controls on average.
Fourteen-hr oxygenated pig heart preservation using COP results in optimal recovery. Storage preservation in solutions containing hyaluronidase (mHTK and EFG) results in higher recoveries as compared to UW solution, an effect that may support the excellent recovery after mHTK-COP preservation.
心脏保存的改进仍然是保存研究中最大的挑战。自临床心脏移植开始以来，心脏移植物可接受保存期的严重限制一直未变，这表明要实现实质性的改进，技术创新是必要的。
在此，我们展示了使用冠状动脉持续氧合（COP）这一创新技术进行低温保存的结果。COP只是在低温移植物保存过程中添加气态氧，并且仅需要一个“瓣膜保护器”来可逆性关闭主动脉瓣。在进行14小时的保存后，进行原位移植，并评估功能以及代谢恢复情况。使用成熟猪心脏，这是一种保存耐受性受限类似于人类心脏的模型，以确保本研究的临床相关性。
经过14小时的低温保存后，COP保存的心脏能够在体外循环2小时内恢复到稳定的心血管功能，无需机械或药物支持。mHTK - COP保存的心脏的左心室压力幅度以及能荷电位恢复到移植前的值，心室功率输出恢复到66%。单纯保存在威斯康星大学（UW）溶液、改良布雷施奈德氏组氨酸 - 色氨酸 - 酮戊二酸（mHTK）溶液或含谷胱甘肽的欧洲冲洗液（EFG）中的心脏恢复有限，平均心室功率输出仅为移植前对照的18%、29%或30%，明显更低。
使用COP对猪心脏进行14小时的氧合保存可实现最佳恢复。与UW溶液相比，保存在含透明质酸酶的溶液（mHTK和EFG）中能实现更高的恢复率，这一效应可能支持mHTK - COP保存后优异的恢复效果。
