A new portable hypothermic perfusion apparatus for long-term heart preservation in canine models

A comparative study of long-term heart preservation using 12-h continuous coronary perfusion versus 1-h coronary perfusion following 11-h simple immersion

PURPOSE

We previously reported the superiority of the continuous coronary perfusion method using apparatus developed in our department. However, myocardial edema was a serious problem following this method. The purpose of this study was to attempt a comparative study of 12-h continuous perfusion and 1-h perfusion following 11-h simple immersion to evaluate the suitable method for long-term heart preservation.

MATERIALS AND METHODS

HBD dogs were used in this study. After measuring baseline hemodynamics, cardiac arrest was attained and the coronary vascular beds were washed out with 4 degrees C Celsior solution. The grafts were divided into the two groups. In the CP group (n = 6), the grafts were preserved by continuous perfusion with 4 degrees C Celsior solution, and in the SI + CP (n = 6) group, the grafts were preserved with 11 h of simple immersion followed by an additional 1 h of perfusion with the same solution. The hemodynamics after orthotopic transplantation were compared. We also performed a histopathologic examination.

RESULTS

Hemodynamics after reperfusion were maintained in both groups, and there were no significant differences in CO, Emax, or the rate pressure product between the two groups. In contrast, the percentage water content was significantly lower in the SI + CP group than in the CP group. Histopathologically, the myocytes were well preserved in both groups. However, ischemia-reperfusion changes were observed more frequently in the CP group than in the SI + CP group.

CONCLUSION

A short-term perfusion following the simple immersion method may provide satisfactory results compared to the continuous perfusion method in long-term heart preservation.

Long-Term Preservation Using a New Apparatus Combined With Suppression of Pro-inflammatory Cytokines Improves Donor Heart Function After Transplantation in a Canine Model

OBJECTIVE

We developed a new apparatus for long-term heart preservation that combines simple immersion with coronary perfusion. In a previous study, we reported that suppression of pro-inflammatory cytokines, such as tumor necrosis factor alpha (TNF-alpha) and interleukin-1beta (IL-1beta), improved results after transplantation. In this study, we evaluated whether long-term preservation using our apparatus for continuous coronary perfusion, combined with suppression of pro-inflammatory cytokines, improves donor heart function after transplantation in a canine model.

METHODS

We used adult mongrel dogs in this study. Coronary vascular beds were washed with University of Wisconsin (UW) solution after arresting hearts with glucose-insulin-potassium solution. The heart was then excised and preserved for 12 hours with a combination of immersion and coronary perfusion using a preservation apparatus. Adult mongrel dogs were divided into 2 groups: the coronary perfusion (CP) group (n = 7) and the FR167653 (FR-CP) group (n = 6). In the CP group, we used a 4 degrees C UW solution for immersion and coronary perfusion. In the FR-CP group, we used a 4 degrees C UW solution supplemented with 20 mg/liter of the anti-inflammatory agent FR167653 for immersion and coronary perfusion. At 2 and at 3 hours after orthotopic transplantation, we compared hemodynamic parameters with pre-operative values in donor animals, with right atrial pressure at 10 mm Hg and with 5 microg/kg/min dopamine infusion. We compared serum concentrations of TNF-alpha from the coronary sinus and compared electron microscopic studies between the 2 groups.

RESULTS

Three hours after transplantation, cardiac output (CO), left ventricular pressure (LVP), and -LVdp/dt were significantly greater (p < 0.05) in the FR-CP group than in the CP group (CO, 178% +/- 65% vs 93% +/- 40%; LVP, 115% +/- 22% vs 73% +/-26%; -LVdp/dt, 168% +/- 13% vs 61% +/- 17%, respectively). Electron microscopic studies showed that glycogen was well preserved in the FR-CP group compared with the CP group. Serum concentrations of TNF-alpha were decreased significantly in the FR-CP group compared with the CP group at 3 hours after reperfusion (161 +/- 54 pg/dl vs 642 +/- 636 pg/dl, respectively).

CONCLUSION

Hemodynamics after transplantation were significantly better in the FR-CP group than in the CP group. The combined preservation method of continuous perfusion and immersion using our apparatus in conjunction with suppression of pro-inflammatory cytokines improves donor heart function after transplantation.

Overview and future practice patterns in cardiac and pulmonary preservation

Heart and lung transplantation have become standard therapy for many patients with end-stage heart and lung disease. Successful transplantation requires preservation of allografts until they can be implanted and reperfused. In the decades since the transplantation of thoracic organs became a clinical reality, many advances have been made in preoperative donor management, procurement, and preservation techniques. This article summarizes the state of the art in heart and lung preservation and review some of the areas of current research that may lead to improvements in preservation techniques in the future.