P130 | CORONARY OXYGEN PERSUFFLATION FOR HEART PRESERVATION |
| |
| Departments of Cardiac Surgery and Institute for Experimental Medicine, University of Cologne, Joseph Stelzmannstr. 9, 50924 Cologne, Germany | |
Objective: In heart tranplantation ischemia time remains one of the most restricting factors. A new approach towards improved myocardial preservation represents the technique of coronary oxygen persufflation (COP) with gaseous oxygen. It is based on previous experimental gaseous oxygenation of normothermic hearts and hypothermic persufflation techniques for livers and kidneys.
Methods: Sixteen hearts of german landrace pigs (body weight: 29 ± 1 kg) were arrested with original Bretschneider's cardioplegic solution (HTK, n = 5) or HTK modified by addition of hyaluronidase (HTH, n = 11) and stored at 0--1°Celsius in the respective solution for 14 hours. Additionally 6 hearts of the HTH group were submitted to continuous coronary oxygen persufflation (HTH + COP) at a pressure of 45 mmHg and a flow of 80 ml/min. Hearts were then orthotopically transplanted in recipient pigs of equal body weight on cardiopulmonary bypass. After 3 hours of blood reperfusion hemodynamic and functional parameters were measured as well as cardiac enzymes and adenine nucleotides from LV biopsies.
Results: After 14 hours of preservation and orthotopic transplantation the HTH + COP hearts showed significantly improved cardiac functional recovery compared to hearts preserved by simple cold storage techniques. Hyaluronidase showed a beneficial effect on postoperative recovery. Hemodynamics were significantly better in the HTH + COP group compared to HTH and HTK: * p < 0.05 versus HTH + COP, # p < 0.05 versus HTH (Anova; post hoc Newman-Keuls test, all values expressed in mean ± SEM)
| HTH + COP | HTH | HTK | ||
| dp/dtmax [mmHg/sec] | 1375 ± 121 | 892 ± 132* | 740 ± 60* | |
| CO [% of baseline] | 68 ± 5 | 44 ± 3* | 25 ± 11*,# |
Postoperative preload recruitable stroke work (PRSW) in the HTH + COP hearts was: 51.9 ± 9.1 mmHg compared to preoperative: 58.9 ± 8.7. ATP of left ventricular myocardium in the HTH + COP group was: 14.7 ± 1.0 µmol/g dry weight (DW) compared to 12.2 ± 2.8 in the HTH group and 7.0 ± 0.5 in the HTK hearts (p < 0.05 versus HTH + COP). CK-MB in percent of CK showed no increase during 3 hours of postoperative reperfusion in either group.
Conclusions: By this study COP has in vivo shown to be a potential alternative respectively complement to recently used cold storage techniques. Further investigations regarding long-term survival and endothelial function will be undertaken prior to clinical application.
