Perfusion Preservation versus Static Preservation for Cardiac Transplantation: Effects on Myocardial Function and Metabolism

David H. Rosenbaum, Matthias Peltz, J. Michael DiMaio, Dan M Meyer, Michael A Wait, Matthew E. Merritt, W Steves Ring, Michael E Jessen

Research output: Contribution to journalArticle

50 Scopus citations

Abstract

Introduction: Continuous perfusion of donor hearts for transplantation has received increasing interest, but the effects on cellular metabolism, myocyte necrosis, and myocardial edema are not well defined. Methods: Pig hearts were instrumented with sonomicrometry crystals and left ventricular catheters. Left ventricular function was quantified by the pre-load-recruitable stroke work (PRSW) relationship. Hearts were arrested with Celsior solution with 5.5mM 13C-glucose added, and removed and stored in cold solution (n = 4) or placed in a device providing continuous perfusion of this solution at 10 ml/100 g/min (n = 4). After 4 hours of storage, left atrial samples were frozen, extracted, and analyzed by magnetic resonance spectroscopy. Hearts were then transplanted into recipient pigs and reperfused for 6 hours, with function measured hourly. At the end of the experiment, left ventricular water content and serum creatine kinase-MB isoenzyme levels were measured. Results: Baseline left ventricular function was similar in both groups. During reperfusion, the volume-axis intercept of the PRSW relationship was significantly lower in hearts stored with continuous perfusion (p < 0.05), suggesting reduced contractile impairment. Magnetic resonance spectroscopy revealed a decrease in tissue lactate in hearts that received continuous perfusion. Serum creatine kinase-MB isoenzyme levels were higher hearts that had static storage (30.8 ± 9.0 vs 13.2 ± 2.7 ng/ml; p < 0.05). Left ventricular water content was similar in both groups (0.797 ± 0.012 vs 0.796 ± 0.014; p = 0.45). Conclusions: Donor hearts sustain less functional impairment after storage with continuous perfusion. This technique reduces tissue lactate accumulation and myocardial necrosis without increasing myocardial edema and appears promising as a method to improve results of cardiac transplantation.

Original languageEnglish (US)
Pages (from-to)93-99
Number of pages7
JournalJournal of Heart and Lung Transplantation
Volume27
Issue number1
DOIs
StatePublished - Jan 1 2008

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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