Abstract
The effect of metabolic inhibitor, hypothermia (4°C) and hyperbaric oxygenation (3 atm) on prolonging survival of the canine anoxic heart has been evaluated. Donor hearts were obtained from small mongrel dogs by giving the pre-cooled perfusate of 2 per cent magnesium sulfate (MgSO4), 5 per cent low molecular weight dextran (LMWD) and 2 per cent glucose into the right atrium. Excised hearts were kept at 4°C in a hyperbaric chamber pressurized to 3 atm. After 18 to 48 hours the preserved hearts were transplanted to the neck of recipients by the methods of Marcus. The viability of the preserved hearts were evaluated with functional, biochemical and histologic parameters.
Of 29 hearts preserved for 18 to 36 hours, 27 hearts returned to a strong coordinated beat and could maintain function for over 4 hours. Of 5 hearts preserved for 48 hours, 4 showed a coordinated ventricular beat, however, failed to maintain cardiac work over 4 hours. The hearts with 18 to 36 hours storage showed no significant abnormalities on myocardial metabolism and morphology as compared to the control group of the immediately transplanted hearts. The protective action of magnesium is probably related to a number of factors, including metabolic depression and stabilizing effect on membrane permeability of cells to potassium, which would tend to maintain a more normal membrane potential and sub-cellular particles. These studies indicate that viability of the mammalian anoxic hearts can be extended to 36 hours by the combined use of metabolic blockade, hypothermia and hyperbaria suggesting a practical approach to procurement and preservation of cadaver organs.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Aikawa, J. K.: The role of magnesium in biologic processes, Charles C. Thomas Co., Springfield, 1963.
Bigelow, W. G., Lindsay, W. K., Harrison, R. E. and Greenewood, W. F.: Oxygen transport and utilization in dogs at low body temperatures, Amer. J. Physiol., 160: 125–137, 1950.
Bing, R. J., Chiba, C., Chrysohou, A., Gudbjarnason, S. and Wolf, P. L.: Metabolic, histologic and histochemical aspects of the hemografted heart, Trans. Ass. A. Physns., 74: 318–332, 1961.
Bloch, J. H., Manax, W. G., Eyal, Z. and Lillehei, R. C.: Heart preservation in vitro with hyperbaric oxygenation and hypothermia, J. Thorac. Cardiov. Surg., 48: 969–983, 1964.
Eyal, Z., Manax, W. G., Bloch, J. H. and Lillehei, R. C.: Utilization of chlorpromazine in heart storage and its combined use with hyperbaric oxygen and hypothermia, Surg. Gynec. Obstet., 120: 1237–1245, 1965.
Gudbjarnason, S., Hayden, R. O., Stock, T. B. and Bing, R. J.: Oxydation reduction in heart muscle. Theoretical and clinical consideration. Circulation, 26: 937–945, 1962.
Holland, W. C.: Action of anesthetic agents on loss of potassium from isolated guinea pig auricles, J. Pharmac. Exp. Ther., 111: 1–8, 1954.
Lee, S. S. and Webb, W. R.: Metabolism of the isolated normothermic and rewarmed heart, Surg. Forum, 9: 284–286, 1959.
Lower, R. R., Stofer, C., Hurley, E. J., Dong, E. Jr. and Shumway, N. E.: Successful homotransplantation of the canine heart after anoxic preservation for seven hours, Amer. J. Surg., 104: 302–306, 1962.
Manax, W. G., Lyons, G. W. and Lillehei, R. C.: Advances in surgery. Vol. II, Transplantation of the small bowel and stomach. Ed. by Welch, C. E., pp. 371–418, Year Book Medical Publ. Inc., Chicago, 1966.
Manax, W. G. and Lillehei, R. C.: Developments and progress in organ preservation, Surgery Annual 1969. Ed. by Cooper, P., pp. 207–237, Appleton Century Croft Co., New York, 1969.
Marcus, E., Wong, S. N. T. and Luisada, A. A.: Homologous heart grafts. I. Technique of interium parabiotic perfusion. II. Transplantation of the heart in dogs, Arch. Surg., 66: 179–191, 1953.
Mommaerts, W. F. H. M. and Seraidarian, K.: A study of the adenosin triphosphate activity of myosin and actomyosin, J. Gen. Physiol., 30: 401–422, 1947.
Nakae, S., Webb, W. R., Salyer, K. E., Unal, M. O., Cook, W. A., Dodds, R. P. and Williams, G. T.: Extended survival of the normothermic anoxic heart with metabolic inhibitors, Ann. Thorac. Surg., 3: 37–42, 1967.
Nakae, S., Todo, K., Kazui, T. and Wada, J.: Organ preservation in vitro with metabolic inhibitors. Extended survival of the hypothermic anoxic heart, Ishoku (Transplantation), 6: 166–170, 1971 (in Japanese).
Proctor, E., Matthews, G. and Archibald, J.: Acute orthotopic transplantation of hearts stored for 72 hours, Thorax, 26: 99–102, 1971.
Theodorides, T., Webb, W. R., Nakae, S. and Sugg, W. L.: Prolonged survival of the anoxic lung with metabolic inhibitors in normothermic and hypothermic conditions, Ann. Thorac. Surg., 5: 411–418, 1968.
Webb, W. R. and Howard, H. S.: Restoration of function of the refrigerated heart, Surg. Forum, 8: 302–306, 1958.
Webb, W. R., Dodds, R. P., Unal, M. O., Karow, A. M. Jr., Cook, W. A. and Daniel, C. R.: Suspended animation of the heart with metabolic inhibitors. Effect of magnesium sulfate or fluoride and adrenochrome in rats, Ann. Surg., 164: 343–350, 1966.
Webb, W. R., Wax, S. D., Jones, F. X., Kamiyama, T., Sugg, W. L. and Ecker, R. P.: Organ perfusion and preservation. Metabolic inhibitors in preservation. Chap. XII, Ed. by Norman, J. C., pp. 121–129, Appleton Century Crofts Co., New York, 1968.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Todo, K., Nakae, S. & Wada, J. Heart preservation with metabolic inhibitor, hypothermia, and hyperbaric oxygenation. The Japanese Journal of Surgery 4, 29–36 (1974). https://doi.org/10.1007/BF02471379
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF02471379