ABSTRACT
The deleterious effect of hyperkalemic cardioplegic solutions on coronary endothelium has been documented and has also been demonstrated with University of Wisconsin solution. We evaluated a new extracellular University of Wisconsin formulation for efficacy in heart preservation. Six neonatal piglet hearts were arrested with and stored in the standard intracellular University of Wisconsin solution (group 1: K+ 125 mEq/L, Na+ 29 mEq/L). Six piglet hearts were preserved for 24 hours with an extracellular University of Wisconsin solution that differed only in the concentrations of potassium and sodium (group 2: K+ 25 mEq/L, Na+ 129 mEq/L). Hearts underwent modified reperfusion with leukocyte-depleted aspartate-glutamate enriched blood cardioplegic solution followed by conversion to a left-sided working mode on a Langendorff circuit with perfusion from a support pig. Stroke work index was calculated at left ventricular end-diastolic pressures of 3, 6, 9, and 12 mm Hg. Sixty minutes after reperfusion, there was no significant difference in stroke work index between group 1 (16.4 +/- 1.9 x 1000 erg/gm) and group 2 (15.3 +/- 2.7 x 1000 erg/gm). There was also no significant difference in high-energy phosphate stores or myocardial water content between the two groups. Extracellular University of Wisconsin solution provides myocardial preservation equivalent to standard University of Wisconsin solution while preventing exposure of coronary endothelium to high levels of potassium, which justifies its use in clinical heart transplantation.
Subject(s)
Heart/physiology , Organ Preservation Solutions , Organ Preservation , Adenosine/chemistry , Adenosine/pharmacology , Allopurinol/chemistry , Allopurinol/pharmacology , Animals , Body Water/metabolism , Coronary Vessels/metabolism , Endothelium, Vascular/metabolism , Extracellular Space/chemistry , Glutathione/chemistry , Glutathione/pharmacology , In Vitro Techniques , Insulin/chemistry , Insulin/pharmacology , Myocardium/metabolism , Myocardium/ultrastructure , Perfusion , Phosphates/metabolism , Potassium/administration & dosage , Potassium/metabolism , Raffinose/chemistry , Raffinose/pharmacology , Sodium/administration & dosage , Swine , Ventricular Function, Left , Ventricular PressureABSTRACT
In the last decade, the number of patients undergoing heart transplantation has steadily increased as a result of expanding indications for cardiac transplantation. The limitation on the number of transplants performed has been the scarcity of donor organs. At UCLA, 320 heart transplant procedures were performed in adults through the end of 1992; 173 patients (54%) underwent transplantation for ischemic cardiomyopathy; 104 (33%) for dilated cardiomyopathy, and 13 (4%) for severe rejection or cardiac allograft vasculopathy. The mean number of rejection episodes and infections per patient per year in the first posttransplant year was 1.28 and 0.58, respectively. Early mortality (30 days) was 5.7%, while 1-, 3-, and 5-year survival rates were 84.3%, 74.3%, and 67.5%, respectively. Survival of patients transplanted for ischemic cardiomyopathy and idiopathic cardiomyopathy was nearly equal. Survival was also comparable in patients aged 60 years and over (n = 71) and those under age 60. We observed improved patient outcome including shorter posttransplant hospital stay, time to extubation, and lower incidences of infections, rejection episodes, and renal failure in patients transplanted in 1991 and 1992. This observation was interesting in view of the increased proportion of critically ill patients in this group (46% UNOS Status 1) compared with patients transplanted in the previous years (30% UNOS Status 1).(ABSTRACT TRUNCATED AT 250 WORDS)
