Long-term cardiac preservation by the combined method of simple immersion and coronary perfusion

本实验采用成年杂种犬（n= 10，8 ~ 13 kg），通过保存和原位移植，对单纯低温保存和冠状动脉灌注相结合的方法进行了长期保存的评价。全身肝素化后，通过结扎腔静脉和奇静脉并交叉夹闭主动脉来分离供体心脏。使用威斯康星州大学（UW）溶液通过主动脉根进行原位初始冲洗以冷却和冠状血管冲洗（20 ml/kg）。然后取出心脏并浸入冷（4 ℃）UW溶液中。单纯低温保存12小时后，再用含氧UW液（20 ml/kg/hr）持续冠状动脉灌注1小时。采用<@D131 @> D1 P-MRS测定心脏采集后即刻、冷藏12小时后和连续灌注后即刻的高能磷酸盐（磷酸肌酸; PCr和β-腺苷三磷酸; β-ATP）和无机磷酸盐（Pi）。 ...更多信息 US冠脉灌注。PCr和β-ATP降至12.1（[SY. ±.]）24.2%（平均值± 0.001）。[)SD)，37.4（±）SY.冷藏12 h后，其含量分别为25.0%和94.0%。48.7%（p<0.001），48.8%（SY. ±.冠脉灌注1小时后，分别为25.8%（p<0.05）。冷保存后观察到的肌细胞核排列紊乱和水肿，在冠状动脉灌注1小时后组织学上恢复。在原位移植保存的移植物后，在仅冷藏12小时的受者（n=7，A组）和冷藏12小时和冠状动脉灌注1小时的受者（n =7，B组）中评估左心室（LV）压力和LVdp/dt。移植后2 h，B组左室压力恢复至76.1%，A组为51.9%，差异有显著性（P<0.01）。移植后2 h，B组左室dp/dt值（83.0%）明显高于A组（68.2%）。提示单纯低温保存结合冠状动脉灌流对心肌长期保存有较好的保护作用。少

The combined method of simple cold storage and coronary perfusion for prolonged preservation was evaluated through preservation and orthotopic transplantation using adult mongrel dogs (n=10,8-13kg). Following systemic heparinization, the donor heart was isolated by ligating the venae cavae and azygos vein, and cross-clamping the aorta. In situ initial flush for cooling and coronary vascular washout (20ml/kg) was performed via an aortic root with a University of Wisconsin (UW) solution. The heart was then removed and immersed into a cold (4ﾟC) UW solution. After 12-hr simple cold storage, 1-hr preservation was added by continuous coronary perfusion a 4ﾟC oxygenated UW solution (20ml/kg/hr). High energy phosphate (phosphocreatine ; PCr, and beta-adenosine triphosphate ; beta-ATP), inorganic phosphate (Pi) were measured by <@D131@>D1P-magnetic resonance spectroscopy (<@D131@>D1P-MRS) at (1) immediately after heart havesting, (2) after 12-hr cold storage, and (3) immediately after continuo … More us coronary perfusion. PCr and beta-ATP were decreased to 12.1(]SY.+-.])24.2% (mean(]SY.+-.[)SD), 37.4(]SY.+-.[)25.0%, respectively after 12-hr cold storage, and significantly increased to 94.0(]SY.+-.[)48.7% (p<0.001), 48.8(SY.+-.[)25.8% (p<0.05), respectively after 1-hr coronary perfusion. Disorder of nuclear arrangement and edema of muscular cells, which were observed after cold storage, were histologically restored after 1-hr coronary perfusion. Following orthotopic transplantation of preserved grafts, left ventricular (LV) pressure and LVdp/dt were evaluated in the recipient with 12-hr cold storage only (n=7, group A) and in the recient with 12-hr cold storage and 1-hr coronary perfusion (n=7, group B). LV pressure 2 hours after transplantation in group B were recovered to 76.1% significantly (p<0.01), compared with 51.9% in group A.Significantly higher values of LVdp/dt 2 hours after transplantation was observed in group B (83.0%) compared to group A (68.2%). These results indicate that the combined method of simple cold storage and coronary perfusion may be effective for myocardial protection during long-term preservation. Less