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Improved preservation of coronary endothelial function with Celsior compared with blood and crystalloid solutions in
L P Perrault1, C Nickner, N Desjardins
1Research Center, Department of Surgery, Montreal Heart Institute, Quebec, Canada. lpperrau@icm.umontreal.ca
Insights
Celsior solution, an antioxidant cardiac preservation fluid, better maintained coronary endothelial function in heart transplant models. This antioxidant capacity may reduce graft vasculopathy and improve transplant outcomes.
Area of Science:
- Cardiovascular Surgery
- Transplantation Immunology
- Vascular Biology
Background:
- Endothelial injury from preservation solutions can cause acute coronary vasospasm and graft coronary vasculopathy after heart transplantation.
- Antioxidant-rich preservation solutions may mitigate these post-transplant complications.
Purpose of the Study:
- To evaluate the efficacy of Celsior solution in preserving coronary endothelial function.
- To compare Celsior with standard cardioplegic and preservation strategies in a heart preservation model.
Main Methods:
- Porcine epicardial coronary arteries were used to assess endothelium-dependent relaxation to serotonin and bradykinin.
- Arteries underwent 4-hour preservation at 4°C using various cardioplegia and storage solutions, including Celsior and saline.
- Organ chamber experiments compared seven preservation groups against a control.
Main Results:
- Serotonin-induced relaxation was significantly reduced in all groups except the Celsior + Celsior group.
- Bradykinin-induced relaxation showed no significant differences across most groups.
- Celsior solution demonstrated superior preservation of endothelium-dependent G-protein-mediated relaxation compared to other strategies.
Conclusions:
- Celsior solution effectively preserves coronary endothelial function, particularly G-protein-mediated relaxation.
- Improved endothelial function may lead to better short- and long-term outcomes in heart transplantation.
- The antioxidant properties of Celsior may play a key role in preventing endothelial dysfunction and subsequent vasculopathy.
Background:
Endothelial injury from preservation solutions has been implicated in acute coronary vasospasm and pathologic activation of the endothelium, which can contribute to the development of graft coronary vasculopathy after heart transplantation. Preservation solutions with a powerful antioxidant capacity may decrease the occurrence of these complications.
Materials And Methods:
This study was designed to evaluate the effect of Celsior (an anti-oxidant solution specifically designed for cardiac preservation) in a model of heart preservation (4 hours at 4 degrees C to reproduce the situation encountered in clinical heart transplantation) compared two commonly used cardioplegic and preservation strategies on coronary endothelial function. Endothelium-dependent relaxation of normal porcine epicardial coronary arteries to serotonin (5-HT, an agonist that activates 5-HT(1d) receptors coupled to Gi proteins) and bradykinin (BK, which activates B2 receptors coupled to Gq proteins) was studied in standard organ chamber experiments in the following groups: a control group was submitted to immediate excision without cardioplegia and preserved in saline solution (0.9% NaCl) for 4 hours (Group 1); two groups had cardioplegia induced with a crystalloid solution and were stored for 4 hours in saline (Group 2) or 4 hours in Celsior solution (Group 3); and two groups had cardioplegia induced with normothermic blood cardioplegia and were stored for 4 hours in the saline (Group 4), or 4 hours in Celsior solution (Group 5). Finally, two groups underwent cardioplegia with Celsior and were stored for 4 hours in saline (Group 6), or 4 hours in the Celsior solution (Group 7). All cardioplegia solutions were at 4 degrees C (except blood cardioplegia at 37 degrees C) and all preservations solutions were at 4 degrees C.
Results:
Endothelium-dependent relaxations to serotonin were significantly decreased in all groups except the Celsior + Celsior group compared with the control group. There were no significant differences in relaxation to bradykinin except in one group. Use of the Celsior solution for induction of cardioplegia and storage better preserved endothelium-dependent G-protein-mediated relaxation compared with the other arrest and preservation strategies.
Conclusions:
The observed effect may be associated with an improvement in both short- and long-term outcome in heart transplantation, especially because these alterations may be further compounded by reperfusion.