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The optimal pressure for initial flush with UW solution in heart procurement
Jun Mohara1, Hirofumi Tsutsumi, Izumi Takeyoshi
1Second Department of Surgery, Gunma University School of Medicine, Maebashi, Gunma, Japan. tcvjun@cb3.so-net.ne.jp
Summary
High-pressure flushing with University of Wisconsin (UW) solution during heart procurement improves graft function and mitochondrial integrity. This method ensures better blood washout and solution distribution, leading to superior outcomes in heart transplantation.
Area of Science:
- Cardiology
- Transplantation Surgery
- Organ Preservation
Background:
- University of Wisconsin (UW) solution is a standard for organ preservation.
- Concerns exist regarding high-pressure flushing potentially causing vasoconstriction and endothelial damage.
- Lower pressures may result in inadequate blood component removal and uneven solution distribution.
Purpose of the Study:
- To evaluate the impact of varying initial flush pressures using UW solution on heart procurement.
- To assess graft hemodynamics and myocardial integrity after 12 hours of preservation and transplantation.
Main Methods:
- Twelve pairs of mongrel dogs were used, with donor hearts flushed with UW solution at either 60 mm Hg (low-pressure) or 120 mm Hg (high-pressure).
- Hearts underwent 12-hour cold preservation followed by orthotopic transplantation.
- Hemodynamic recovery, Endothelin-1 (ET-1) levels, adenosine triphosphate (ATP) content, and mitochondrial histology were assessed.
Main Results:
- High-pressure flushing led to significantly better cardiac output, left ventricular pressure (LVP), and myocardial ATP content (p < 0.05).
- Mitochondrial degeneration was less severe in the high-pressure group.
- No significant differences in ET-1 levels or endothelial cell ultrastructural damage were observed between groups.
Conclusions:
- High-pressure flushing with UW solution is superior for complete blood washout and uniform distribution during heart procurement.
- This technique enhances graft function and preserves myocardial integrity.