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Vivek Rao
Christopher M. Feindel
Gideon Cohen
Michael A. Borger
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Right arrow Transplantation - heart

J Thorac Cardiovasc Surg 2001;122:501-507
© 2001 The American Association for Thoracic Surgery

Cardiothoracic Transplantation (TX)

Is profound hypothermia required for storage of cardiac allografts?

Vivek Rao, MD, PhD, Christopher M. Feindel, MD, Gideon Cohen, MD, PhD, Michael A. Borger, MD, Patty Boylen, Heather J. Ross, MD

From the Heart Transplant Program, University of Toronto; Divisions of Cardiology and Cardiovascular Surgery, The Toronto Hospital, Toronto, Ontario, Canada.

Supported by the Heart and Stroke Foundation of Canada (grant NA-4043).

Received for publication Oct 17, 2000. Revisions requested Dec 1, 2000; revisions received March 21, 2001. Accepted for publication March 23, 2001. Address for reprints: Christopher M. Feindel, MD, EN 14-222, The Toronto Hospital, 200 Elizabeth St, Toronto, Ontario, Canada M5G 2C4.

Abstract

Background: Improved methods of cardiac allograft protection are required to expand the pool of potentially available organs and to enhance the recovery of grafts subjected to prolonged ischemia. We have previously demonstrated that limited coronary perfusion provided by donor blood harvested at the time of organ procurement can improve both metabolic and functional recovery after transplantation. In this study we evaluated the hypothesis that limited coronary perfusion may enable prolonged cardiac storage while avoiding the potentially detrimental effects of profound hypothermia.
Methods: Fourteen orthotopic cardiac transplants were performed in female Yorkshire pigs by using donor blood perfusion during 5 hours of either tepid (25°C) or cold (4°C) storage. Assessments of myocardial metabolism and function were performed at baseline and after 45 minutes of normothermic (37°C) reperfusion.
Results: Hearts protected with tepid perfusion displayed improved recovery of myocardial function (89% ± 18% vs 63% ± 25%, P = .05). Diastolic compliance was adversely affected in both groups after transplantation. Aerobic myocardial metabolism was better preserved in the tepid group.
Conclusions: Profound hypothermia results in depressed myocardial metabolic and functional recovery after transplantation. Limited coronary perfusion with shed donor blood can permit cardiac allograft storage at tepid temperatures, resulting in improved myocardial performance.






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Copyright © 2001 by The American Association for Thoracic Surgery.