Improvement of perfusion apparatus for long-term heart preservation to practical use

背景资料。我们研制了一种简单浸泡和冠状动脉持续灌流相结合的心脏保存装置。我们用24小时保存的心脏和移植的非心脏跳动供者(NHBD)心脏，研究了冠脉灌流的效果。材料和方法将杂种犬随机分为两组。在单纯浸泡(SI)组，心脏被简单地浸泡在4℃摄氏度的溶液中。冠脉灌注组(CP)将心脏浸泡在4℃摄氏度的溶液中，并使用该装置灌流相同的含氧液。在体外循环(CPB)下撤机2小时后测定心功能。1)保存24小时心脏：切取心脏后即刻和保存24小时后，用核磁共振测定心肌高能磷酸盐水平。保存后行原位移植。2)NHBDS心脏：快速失血诱导心脏骤停后，供心原位放置20min。保存4小时后行原位移植。CP组心脏仅灌流1小时，以防止心肌水肿。结果。1)保存24小时后，CP组心肌高能磷酸盐水平显著高于SI组(p&lt；0.05)。心功能恢复率CP组优于SI组。2)心功能恢复率CP组明显高于SI组(P<0.05)。CP组心肌水肿程度不明显。结论。这些研究的结果表明，冠状动脉灌注对于保存24小时后的心脏和边缘供者心脏可能是有用的。该装置可稳定、安全地保存犬心脏，并结合冠脉持续灌注和浸泡，具有广阔的临床应用前景。

Background. We developed a new apparatus for heart preservation combined with simple immersion and continuous coronary perfusion. We investigated the effects of coronary perfusion using the apparatus with 24 hr-preservation hearts and non-heart-beating donors (NHBDs) hearts through transplantation. Materials and Methods. Mongrel dogs were divided into two groups. In the simple immersion (SI) group, the hearts were simply immersed in a 4 ℃ Celsior solution. In the coronary perfusion (CP) group, hearts were immersed in a 4℃ Celsior solution and perfused with the same oxygenated solution using the apparatus. Cardiac function was measured 2 hr after weaning from cardiopulmonary bypass (CPB). 1) 24 hr-preservation hearts : Myocardial high-energy phosphate levels were measured immediately after the heart was excised and at 24 hr after preservation using ^<31>P nuclear magnetic resonance. Following preservation, orthotopic transplantation was performed. 2) NHBDs hearts : Donor hearts were left in situ for 20 min after cardiac arrest was induced by rapid exsanguination. Orthotopic transplantation was performed after 4 hr-preservation. In the CP group, hearts were perfused only for the first hour to prevent myocardial edema. Results. 1) Myocardial high-energy phosphate levels were significantly higher in the CP group than in the SI group 24 hr after preservation (p<0.05). The recovery rates of cardiac function were better in the CP group than in the SI group. 2) The recovery rates of cardiac function were significantly higher in the CP group than in the SI group (p<0.05). Myocardial edema was not more severe in the CP group. Conclusions. The results of these studies suggest that coronary perfusion may be useful for hearts after 24 hr-preservation and marginal donor hearts from NHBDs. Stable and safe canine heart preservation with continuous coronary perfusion associated with immersion is possible using this apparatus, and may have broad clinical application.