The paucity of donor hearts for transplantation can be remedied by distant heart procurement. Prolonging donor heart preservation is essential for successful clinical cardiac transplantation. Thirty-two isolated rat hearts were perfused with
Krebs-Henseleit buffer solution for 15 minutes, arrested and preserved at 4℃ for 4 hours. and then reperfused for 25 minutes. The following three groups were prepared and hemodynamic changes, creatine kinase-MB isoenzyme levels and
ultrastructural
changes of the myocardium were analysed before and after cardiac arrest. :Group I :the heart was arrested with the cardioplegic solution(Plegisol, potassium :16mM, sodium :120mM) and then stored in a solution with ilinc compositions of the
extracellular
fluid (Hartman, potassium :4mM, sodium :130mM); Group II :the heart was arrested with the cardioplegic solution and stored in a solution with ionic compositions of the intracellular fluid(Modified Euro-Collins, potassium: 108mM, sodium: 10mM)
;Group
III: the heart was arrested with the cardioplegic solution containing adenosine 20uM, and the stored in a solution with ionic compositions of the intracellular fluid (Modified University of Wisconsin solution, potassium :119mM, sodium :23mM).
Left ventricular developed pressure at 20 minutes of the reperfusion was significantly higher in group III(64.3*3.12mmHg. p<0.01) and group II(58.3*1.55mmHg, p<0.05) as compared with group I(51.4*2.78mmHg).
The time to induce cardiac arrest after infusion of cardioplegic solution with adenosine 20uM (5.3*0.30 second, p<0.005) was significantly shorter than without adenosine (10.6*0.55 second).
Coronary flow at 20 minutes of the reperfusion was augmented significantly in group III (9.6*0.50 ml/min, p<0.05, p<0.05) as compared with group I(8.00.41 m/min)) and group II (8.1*0.51ml/min).
Percentage recovery of left ventricular developed pressure at 20 minutes of the reperfusion was significantly higher in group III (94.6*2.51%, p<0.005) as compared with group II and in group II (83.1*1.22%, p<0.005) as compared with group I
(69.9*1.73%). and also percentage recovery of coronary flow at 20 minutes of the reperfusion was significantly higher in group III (82.3 3.86%, p<0.05) as compared with group II (71.4*3.46%) but there was no significant difference between group I
and
group II.
Measured level of creatine kinase-MB isonenzyme at 15 minutes of the reperfusion was significantly lower in group III (1.23*0.16ng/ml, p<0.025) and group II (1.42*0.10ng/ml, p<0.05) as compared with group I (1.79*0.14ng/ml).
In the semiquantitative evaluation of the ultrastructural changes of the myocardium, mitochondrial score was lower in group III (0.7*0.21) than in group I (3.1*0.28) and group II (1.7*0.19), and also the other structural score was lower in group
III
(2.7*0.99) than in group I (7.9*0.89) and group II (5.0*1.22).
In conclusion, the solution with ionic compositions of the intracellular fluid is appropriate for prolonged cardiac preservation, and it appears to be better preserving method for distant procurement when the donor heart is rapidly arrested with
cardioplegic solution containing adenosine 20uM, and then stored with Modified University of Wisconsin solution. (Korean J Thoracic Cardiovas Surg 1994; 27:427-440)
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