Title of article :
Optimizing Donor Heart Outcome After Prolonged Storage With Endothelial Function Analysis and Continuous Perfusion
Author/Authors :
Robert S. Poston، نويسنده , , Junyan Gu، نويسنده , , Deyanira Prastein، نويسنده , , Fred Gage، نويسنده , , John W. Hoffman، نويسنده , , Michael Kwon، نويسنده , , Agnes Azimzadeh، نويسنده , , Richard N. Pierson III، نويسنده , , Bartley P. Griffith، نويسنده ,
Issue Information :
روزنامه با شماره پیاپی سال 2004
Pages :
9
From page :
1362
To page :
1370
Abstract :
Background By minimizing tissue ischemia, continuous perfusion (CP) during organ transport may increase the safety of “marginal donors.” My colleagues and I investigated whether an analysis of donor heart viability predicts recovery of grafts challenged with a 24-hour preservation interval. Methods Dog hearts underwent cold static storage (CS) for 8 hours (n = 8) or 24 hours (n = 2) or CP for 24 hours with cold asanguinous, oxygenated solution (n = 8). Myocardial systolic and diastolic function and oxygen and lactate consumption were assessed at base line, during CP, and after Langendorff blood reperfusion. Base line endothelial function was evaluated by the percentage transcoronary change ([coronary sinus − aorta]/aorta) in myeloperoxidase and by platelet function and coronary flow reserve after 20 seconds of coronary artery occlusion. During CP, the endothelium was assessed by transcoronary protein release and coronary resistance. Edema was assessed by weight gain and histology. Results Base line systolic and metabolic functions showed no relation to post-Langendorff function. Compared with CS, CP resulted in a greater recovery in systolic function (87% ± 35% vs 65% ± 15% of baseline; p = 0.05) and a shorter interval required for lactate consumption to exceed production (7.0 ± 6.8 minutes vs 15.0 ± 8.9 minutes; p = 0.06). Endothelial function was heterogeneous: coronary flow reserve, 2.7 ± 0.7; percentage change in myeloperoxidase, −8.4% ± 6.8%; and change in platelet function, 4.3% ± 3.5%, as determined by thromboelastography angle at base line. Protein release during CP for 24 hours was 8.3 ± 7.1 g. Two factors predicted more than 75% systolic pressure generation recovery: use of CP and normal endothelial function (p = 0.05; Fisherʹs exact test). However, CP led to edema according to histology, weight gain (72 ± 29 g), and impaired diastolic function versus CS (end-diastolic pressure-volume relationship, 1.4 ± 0.4 mm Hg/mL vs 0.8 ± 0.3 mm Hg/mL; p = 0.08). Conclusions Better systolic function despite 16 hoursʹ more preservation than cold storage corroborates the idea that CP supports aerobic metabolism at physiologically important levels. Viability analysis focused on endothelial function and identified organs that were able to tolerate this 24-hour preservation interval.
Journal title :
The Annals of Thoracic Surgery
Serial Year :
2004
Journal title :
The Annals of Thoracic Surgery
Record number :
607997
Link To Document :
بازگشت