Abstract
In distant heart procurement, optimal storage conditions remain to be defined, especially with respect to the electrolytic concentrations of storage solutions. Between December 1986 and April 1987, heart transplants were carried out in 18 patients. After cardioplegic arrest (St. Thomas), the hearts were randomly stored in either Euro-Collins' solution (ECS; n=9) or Ringer's solution (RS; n-9) at 4°C. For the first 24 h postsurgery, atrial pressures (LAP, RAP), systemic (MAP) and pulmonary pressures (LAP), and cardiac output (CO) were monitored. In addition, catecholamine and nitroglycerine requirements as well as the type of cardiac rhythm were documented. There was no significant difference between the groups in terms of the period of graft ischemia (ECS, 162±28 min; RS, 141±47 min); the MAP, RAP, LAP, and CO were also similar in both groups. The total amount of epinephrine needed to maintain the MAP between 60 and 80 mm Hg was 10.5 mg/24 h±4.1 mg in ECS compared with 19.9 mg/24 h±12 mg in RS (P<0.05). Despite less inotropic support, the left cardiac work index was considerably higher in the ECS group (P<0.05). In the first few postoperative hours, 8/9 RS patients needed either atrial (n=4) or ventricular pacing (n=4) for a heart rate of 90–100 beats/min (bpm), whereas only three ECS patients required atrial pacing (P<0.05). All other ECS hearts showed a spontaneous sinus rhythm. At the 24th postoperative h eight RS patients remained pacemaker-dependent, as opposed to two ECS patients with atrial and one with ventricular pacing. We conclude that storage of the donor heart in a medium with intracellular ionic composition, such as ECS, is superior to RS (extracellular composition). ECS appears to result in better preservation of cardiac performance and electrical stability of the transplanted heart.
Similar content being viewed by others
References
Baumgartner WA, Reitz BA, Oyer PE, Stinson EB, Shumway NE (1979) Cardiac homotransplantation. Curr Probl Surg 16: 1–61
Buckberg GD (1986) Studies of controlled reperfusion after ischemia. J Thorac Cardiovasc Surg 92: 483–487
Collins GM, Bravo-Shugarman M, Teraski PI (1969) Kidney preservation for transportation. Lancet II: 1219–1222
Collins GM, Peterson T, Wicomb WN, Halasz NA (1984) Experimental observation on the mode of action of “intracellular” flush solution. J Surg Res 36: 1–8
Foreman J, Pegg DE, Armitage WJ (1985) Solutions for preservation of the heart at 0°C. J Thorac Cardiovasc Surg 89: 867–871
Ganz W, Swan HJC (1972) Measurement of blood flow by thermal dilution. Am J Cardiol 29: 241–246
Green CJ, Pegg DE (1979) Mechanism of action of “intracellular” renal preservation solutions. World J Surg 3: 115–120
Jennings RB, Ganote CE (1974) Structural changes in the myocardium during acute ischemia. Circ Res [Suppl 3] 34/35: 156–172
Kaye MP (1987) The registry of the International Society for Heart Transplantation. 4th official report — 1987. J Heart Transplant 6: 63–64
Kohno H, Shiki K, Ueno Y, Tokunaga K (1987) Cold storage of the heart for transplantation. J Thorac Cardiovasc Surg 93: 86–94
McCabe M, Cunningham GJ, Wyatt AP, Novitzky D (1972) Vein grafts: changes in phospholipid structure due to storage in saline solution. Lancet II: 109–114
McGregor CG, McCallum HM, Hannan J, Smith AF, Muir AL (1984) Long-term effects of cold cardioplegic myocardial protection in the rat. J Thorac Cardiovasc Surg 87: 913–919
Ross H, Marshal VC, Escott ML (1976) 72-Hour canine kidney preservation without continuous perfusion. Transplantation 21: 498–501
Schubö W, Uehlinger H-M (1986) SPSSx Handbuch der Programmversion 2.2. Fischer, Stuttgart
Shoemaker WC, Chang P, Czer L, Blond R, Shabot MM, State D (1979) Cardiorespiratory monitoring in postoperative patients. Crit Care Med 7: 237–242
Thomas T, Schatzki PF, Hudson BH, Wolf JS (1975) Successful 24-hr ischemic cardiac preservation using a new hyperosmolar perfusate. Surg Forum 26: 253–255
Author information
Authors and Affiliations
About this article
Cite this article
Hausen, B., Fieguth, H.G., Schäfers, H.J. et al. Distant heart procurement. Transplant Int 1, 140–145 (1988). https://doi.org/10.1007/BF00348836
Issue Date:
DOI: https://doi.org/10.1007/BF00348836