Ischemia-reperfusion injury
Experimental: Thoracic
Importance of Organ Preservation Solution Composition in Reducing Myocardial Edema during Machine Perfusion for Heart Transplantation

https://doi.org/10.1016/j.transproceed.2010.02.073Get rights and content

Abstract

Objective

Machine perfusion preservation has been used experimentally to extend the storage interval of donor hearts. We previously demonstrated that machine perfusion with glucose-supplemented Celsior preservation solution led to superior reperfusion function but resulted in increased myocardial edema compared with conventional static preservation. We hypothesized that other solutions that contain an oncotic agent, such as University of Wisconsin Machine Perfusion Solution (UWMPS), might reduce graft edema development while maintaining myocardial oxidative metabolism during long-term storage.

Methods

Canine hearts were stored and perfused in a perfusion preservation device (LifeCradle; Organ Transport Systems) after cardioplegic arrest and donor cardiectomy. Hearts were perfused either with glucose-supplemented Celsior (which lacks an oncotic agent) or UWMPS (which contains hydroxyethyl starch) at 5°C in the perfusion device over 10 hours. Oxygen consumption (MVO2), lactate accumulation, regional flow distribution, and myocardial water content were measured.

Results

Hearts in both groups continued to extract oxygen over the entire perfusion interval. Lactate accumulation was minimal in both groups. Both solutions delivered perfusate evenly to all regions of myocardium. Heart weight increase (Celsior 31.3 ± 4.3%, UWMPS −3.3 ± 1.9%) and final myocardial water content (Celsior 80.2 ± 1.3%, UWMPS 75.9 ± 0.3%) were higher in the Celsior group (P < .005).

Conclusions

Donor hearts can be supported by a perfusion device over relatively extended storage intervals. These organs continue to undergo oxidative metabolism with little lactate accumulation. An oncotic agent appears to be important in limiting increases in myocardial water content. UWMPS appears to be superior for perfusion preservation of myocardium by reducing edema development during storage.

Section snippets

Experimental Protocol

The protocol for this study was approved by the Institutional Animal Care and Use Committee at the University of Texas Southwestern Medical Center. All animals were treated within guidelines set forth in the Guide for the Care and use of Laboratory Animals (National Institutes of Health Publication no. 86-23, revised 1996). Adult mongrel dogs were used in this experiment. In each experiment, hearts were removed from anesthetized dogs and established in a perfusion device that provided

Myocardial Edema

Tissue weight change over the preservation interval differed significantly between the Celsior and UWMPS groups. After 10 hours of perfusion, heart weight in the Celsior group increased by 31.3 ± 4.3%, whereas heart weight in the UWMPS group decreased by 3.3 ± 1.9% (P < .001). Similarly, LV water content at the end of the preservation interval was significantly higher in the Celsior group (80.2 ± 1.3%) than in the UWMPS group (75.9 ± 0.3%; P < .005; Fig 1, Fig 2).

Oxygen Consumption and Myocardial Metabolism

Despite increased edema

Discussion

Current heart preservation strategies involving cardioplegic arrest and cold immersion in the preservation solution have not changed substantially since long-distance transplantation procedures originated. Machine perfusion has moved into the clinical arena for other organs and has proven to be clinically superior to hypothermic static storage of renal allografts.12 Experimental data suggest that for heart preservation, machine perfusion provides homogenous myocardial nutrient delivery,

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