HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Menasche, P. Articles by Piwnica, A. Search for Related Content PubMed PubMed Citation Articles by Menasche, P. Articles by Piwnica, A.

The Journal of Thoracic and Cardiovascular Surgery, Vol 105, 353-363, Copyright © 1993 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Improved recovery of heart transplants with a specific kit of preservation solutions

P Menasche, F Pradier, C Grousset, J Peynet, C Mouas, G Bloch and A Piwnica
Department of Cardiovascular Surgery, Hopital Lariboisiere, Paris, France.

In the course of cardiac transplantation, donor hearts undergo a four- step sequence of events (arrest, cold storage, global ischemia during implantation, and reperfusion) during which myocardial damage can occur. We tested the hypothesis that the functional recovery of these hearts could be improved by exposure to two interdependently formulated preservation solutions throughout this four-step sequence. Solution I was used as a perfusion and storage medium during the first three steps, and solution II served as a modified reperfusate. The two solutions share the following principles of formulation: prevention of cell swelling (high concentrations of mannitol, a myocardium-specific impermeant) calcium overload (ionic manipulations), and oxidative damage (reduced glutathione) and enhancement of anaerobic energy production (glutamate). The two solutions differ with respect to the calcium content and buffering capacity. One hundred rat hearts perfused with isolated isovolumic buffer were subjected to cardioplegic arrest; cold (2 degrees C) storage for 5 hours, global ischemia at 15 degrees C for 1 hour, and normothermic reperfusion for 1 additional hour. In a first series of experiments (70 hearts), our kit of solutions was compared with six clinical preservation regimens that involved cardiac arrest with St. Thomas' Hospital or University of Wisconsin solutions followed by storage of the hearts in saline, Euro-Collins, St. Thomas' Hospital, or University of Wisconsin solutions. In a second series of experiments (30 hearts), the effects of the kit were more specifically investigated in relation to two types of additive--oncotic agents (dextran) and thiol-based antioxidants (reduced glutathione and N- acetyl-L-cysteine). According to comparisons of maximal rate of ventricular pressure increase and left ventricular compliance after reperfusion, the best myocardial protection was afforded by our kit of solutions. The addition of dextran during storage did not provide additional protection. Conversely, the omission of reduced glutathione was clearly detrimental; the replacement of reduced glutathione with N- acetyl-L-cysteine failed to improve recovery beyond that provided by antioxidant-free solutions, thereby suggesting the importance, in this model, of an anti-free radical compound that, like reduced glutathione, is operative extracellularly. We conclude that the preservation of heart transplants can be improved with the sequential use of two closely interrelated solutions, the formulations of which integrate the basic principles of organ preservation with those of myocardium- specific metabolism.

This article has been cited by other articles:

				D. Pereda, M. Castella, J.-L. Pomar, R. Cartana, M. Josa, C. Barriuso, J. Roman, and J. Mulet Elective cardiac surgery using Celsior or St. Thomas No. 2 solution: a prospective, single-center, randomized pilot study Eur. J. Cardiothorac. Surg., September 1, 2007; 32(3): 501 - 506. [Abstract] [Full Text] [PDF]

				F. Nicolini, C. Beghi, C. Muscari, A. Agostinelli, A. M. Budillon, I. Spaggiari, and T. Gherli Myocardial protection in adult cardiac surgery: current options and future challenges Eur. J. Cardiothorac. Surg., December 1, 2003; 24(6): 986 - 993. [Abstract] [Full Text] [PDF]

				J. Ackemann, W. Gross, M. Mory, M. Schaefer, and M.-M. Gebhard Celsior versus custodiol: early postischemic recovery after cardioplegia and ischemia at 5{degrees}C Ann. Thorac. Surg., August 1, 2002; 74(2): 522 - 529. [Abstract] [Full Text] [PDF]

				J.-P. Remadi, O. Baron, J. C. Roussel, O. Al Habash, M. Treilhaud, P. Despins, D. Duveau, and J.-L. Michaud Myocardial preservation using celsior solution in cardiac transplantation: early results and 5-year follow-up of a multicenter prospective study of 70 cardiac transplantations Ann. Thorac. Surg., May 1, 2002; 73(5): 1495 - 1499. [Abstract] [Full Text] [PDF]

				J. D. Vega, J. L. Ochsner, V. Jeevanandam, D. C. McGiffin, K. R. McCurry, R. M. Mentzer Jr, J. C. Stringham, R. N. Pierson III, O.H. Frazier, A. H. Menkis, et al. A multicenter, randomized, controlled trial of Celsior for flush and hypothermic storage of cardiac allografts Ann. Thorac. Surg., May 1, 2001; 71(5): 1442 - 1447. [Abstract] [Full Text] [PDF]

				J. K. Kirklin and D. C. McGiffin Control of the inflammatory response in extended myocardial preservation of the donor heart Ann. Thorac. Surg., November 1, 1999; 68(5): 1978 - 1982. [Abstract] [Full Text] [PDF]