Functional, Metabolic, and Morphological Aspects of Continuous, Normothermic Heart Preservation: Effects of Different Preparation and Perfusion Techniques
Functional, Metabolic, and Morphological Aspects of Continuous, Normothermic Heart Preservation: Effects of Different Preparation and Perfusion Techniques
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DOI：
10.1089/ten.tec.2008.0475
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发表时间：
2009-06-01
影响因子：
3
通讯作者：
Mohr, Friedrich-Wilhelm
中科院分区：
文献类型：
--
作者：
Garbade, Jens;Krautz, Christian;Mohr, Friedrich-Wilhelm
供心的连续血液灌注已成为越来越多的研究热点，但最佳的制备和灌注技术尚未明确定义。因此，我们研究了不同的保存策略的有效性，连续，常温心脏灌注供体心脏收获后。将12只猪的心脏随机分为两组，在改良的Langendorff系统中接受不同制备技术后的恒压灌注。第1组，6个心脏用Bretschneider HTK停搏液（4 ℃）停搏，然后用去白细胞的自体血在80 - 90 mmHg的循环压力下再灌注。第2组6只猪，心脏不停跳，同时灌注，不停搏。收获后灌注与第1组相似，但循环压较低（40-50 mm Hg）。在不同的时间点（基线和再灌注后1、6和12小时），进行心肌活检，并通过测量左心室压力上升的最大速率（Δ p/Δ t（max））来评估收缩力。使用生物发光技术测量所有活检组织中的三磷酸腺苷（ATP）浓度。此外，超微结构的变化进行了研究，使用电子显微镜。低温停搏液和较高的再灌注压力（组1）与收缩功能和细胞内ATP浓度的早期和急剧下降有关。第1组的超微结构改变出现较早，比第2组更有特色。尤其是内皮超微结构，在第2组中保存得更好。灌注12小时后，两组均出现显著变化，但第1组更为严重。血液灌注在有限的时间内提供对严重缺血性损伤的保护。使用较低的灌注压，以及避免心脏停搏液和低温，导致灌注心脏的保存明显更好和更长。
Continuous blood perfusion of donor hearts for transplantation has been the focus of an increasing amount of research, but the optimal preparation and perfusion techniques have not been clearly defined. Therefore, we investigated the effectiveness of different preservation strategies using continuous, normothermic heart perfusion after donor heart harvesting. Hearts of 12 pigs were randomly assigned to two groups receiving a constant pressure perfusion in a modified Langendorff system after different preparation techniques. In Group 1, six hearts were arrested with Bretschneider HTK cardioplegia (4 degrees C) and then reperfused with a circulating pressure of 80 to 90mmHg using leukocyte depleted autologous blood. In Group 2, beating hearts of six pigs were explanted while being perfused, without cardioplegic arrest. Post-harvesting perfusion was similar to Group 1 except for a lower circulating pressure (40-50 mm Hg). At different time points (baseline and 1, 6, and 12 h after reperfusion), myocardial biopsies were taken, and contractility was assessed by measuring the maximum rate of left ventricular pressure rise (Delta p/Delta t (max)). Adenosine triphosphate (ATP) concentration was measured in all biopsies using a bioluminescence technique. Additionally, ultrastructural alterations were investigated using electron microscopy. Hypothermic cardioplegia and a higher reperfusion pressure (Group 1) were associated with an earlier and sharper decline in contractile function and intracellular ATP concentration. Ultrastructural alterations in Group 1 appeared earlier and were more distinctive than in Group 2. Endothelial ultrastructure, in particular, was better preserved in Group 2. Significant alterations were present in both groups after 12 h of perfusion but were more severe in Group 1. Blood perfusion provides protection against severe ischemic damage for a limited time. The use of a lower perfusion pressure, as well as avoiding cardioplegia and hypothermia, led to significantly better and longer preservation of perfused hearts.