Martin J, Sarai K, Yoshitake M, Haberstroh J, Takahashi N, Lutter G, Beyersdorf F
Department of Cardiovascular Surgery, Albert-Ludwigs-University Medical Center, Freiburg, Germany.
Eur J Cardiothorac Surg. 1998 Dec;14(6):607-14. doi: 10.1016/s1010-7940(98)00236-x.
The aim of our study was to develop a surgical technique for a successful transplantation of hearts harvested after 30 min of normothermic ischemia without donor pretreatment. Successful transplantation of ischemic compromised hearts could help to expand the severely limited donor pool. We used the pig model because this species is very susceptible to myocardial ischemia. Na+-H+-exchange (NHE) inhibitors have shown excellent protective properties in several in vitro and in vivo models of myocardial ischemia and reperfusion.
In group I (n=12) hearts were harvested after 30 min of normothermic ischemia following cardiac arrest induced by exsanguination. Hearts were perfused with warm blood cardioplegia and transplanted orthotopically. In group II (n=9) controlled reperfusion with cold leucocyte-depleted blood cardioplegia was performed after 30 min of normothermic ischemia. In group III (n=8) the same procedure was performed as in group II but blood cardioplegia contained 1 mmol/l HOE 642.
In group I massive myocardial oedema was observed and none of the animals could be weaned from cardiopulmonary bypass (CPB). In contrast, all animals in groups II and III could be weaned from CPB with low dose inotropic support. In groups II and III the contractility of the hearts, expressed as maximal left and right ventricular stroke work index was significantly impaired after transplantation as compared with the preoperative value. Supplementation of blood cardioplegia with HOE 642 resulted in a significantly better recovery of the LVSWImax (Group II vs. III).
Successful transplantation of pig hearts is possible after 30 min of normothermic ischemia without donor pretreatment if a controlled reperfusion with cold leucocyte-depleted blood cardioplegia is performed. HOE 642 given during reperfusion only improves posttransplant left ventricular function.
我们研究的目的是开发一种手术技术，用于在不进行供体预处理的情况下成功移植常温缺血30分钟后获取的心脏。成功移植缺血受损心脏有助于扩大严重受限的供体库。我们使用猪模型，因为该物种对心肌缺血非常敏感。钠氢交换（NHE）抑制剂在几种心肌缺血和再灌注的体外和体内模型中均显示出优异的保护特性。
在第一组（n = 12）中，通过放血诱导心脏骤停后进行30分钟常温缺血，然后获取心脏。心脏用温血心脏停搏液灌注并原位移植。在第二组（n = 9）中，常温缺血30分钟后用冷的去白细胞血液心脏停搏液进行控制性再灌注。在第三组（n = 8）中，进行与第二组相同的操作，但血液心脏停搏液含有1 mmol/l HOE 642。
在第一组中观察到大量心肌水肿，所有动物均无法脱离体外循环（CPB）。相比之下，第二组和第三组的所有动物在低剂量正性肌力支持下均可脱离CPB。与术前值相比，第二组和第三组心脏的收缩力，以最大左、右心室搏功指数表示，在移植后明显受损。血液心脏停搏液中添加HOE 642导致左心室最大搏功指数（LVSWImax）的恢复明显更好（第二组与第三组）。
如果用冷的去白细胞血液心脏停搏液进行控制性再灌注，在不进行供体预处理的情况下，常温缺血30分钟后猪心脏成功移植是可能的。再灌注期间给予HOE 642仅能改善移植后的左心室功能。
