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

背景。我们研制了一种简单浸泡和冠状动脉连续灌注相结合的心脏保存装置。我们研究了24小时保存心脏和非心脏跳动供者（NHBDs）心脏移植后冠脉灌注的影响。材料与方法。杂种狗被分成两组。简单浸泡（SI）组，心脏简单浸泡在4℃的温度溶液中。冠状动脉灌注（CP）组，心脏浸泡在4℃的Celsior溶液中，并用该仪器灌注相同的含氧溶液。在体外循环（CPB）脱机后2小时测量心功能。1)保存24小时的心脏：在心脏切除后立即和保存24小时时，使用^<31>P核磁共振测量心肌高能磷酸盐水平。保存后，进行原位移植。2) NHBDs心脏：快速放血诱导心脏骤停后，供体心脏原地放置20分钟。保存4小时后进行原位移植。在CP组，心脏仅灌注1小时以防止心肌水肿。结果：1)保存24 h后，CP组心肌高能磷酸盐水平显著高于SI组（p<0.05）。CP组心功能恢复率优于SI组。2) CP组心功能恢复率显著高于SI组（p<0.05）。CP组心肌水肿不加重。结论。这些研究结果表明，冠状动脉灌注可能对保存24小时后的心脏和来自NHBDs的边缘供体心脏有用。使用该装置可以稳定、安全地保存犬心脏，持续冠脉灌注与浸泡相结合，具有广泛的临床应用价值。

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.