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Updated: Sep 29, 2026
Innovative Strategies for Organ Preservation in Heart Transplantation: Uniform Cooling Preservation and Ex-situ Normothermic Perfusion
Published on: November 28, 2025
A comparative study of the most widely used solutions for cardiac graft preservation during hypothermia
Pierre Michel1, Remi Vial, Claire Rodriguez
1Institut Fédératif de Recherche Cardiovasculaire, Lyon, France.
Insights
Celsior and Lyon Preservation Solution (LYPS) demonstrated superior heart preservation compared to other cardioplegic solutions. Extracellular solutions generally outperformed intracellular ones, with calcium potentially enhancing preservation quality.
Area of Science:
- Cardiology
- Transplantation Medicine
- Biochemistry
Background:
- Conflicting reports exist regarding the efficacy of various cardioplegic preservative solutions.
- This study compares widely used extracellular and intracellular cardioplegic solutions.
Purpose of the Study:
- To evaluate the efficacy of different cardioplegic solutions in preserving heart function post-cold storage.
- To identify optimal solutions for cardiac preservation.
Main Methods:
- Male rats (n=110) were randomized into 11 groups, including various cardioplegic solutions (Celsior, STH-1/2, UW-1, LYPS, UW, HTK, EC) and controls.
- Hearts were preserved via cold storage (8 hours at 4°C) and assessed using an isolated non-working heart model and biopsy specimens.
Main Results:
- Celsior and LYPS solutions provided preservation comparable to controls, significantly outperforming Euro-Collins and saline solutions.
- Other solutions (STH-1/2, UW-1, UW, HTK, STF) showed intermediate functional responses.
- Increased release of creatine kinase and lactate dehydrogenase, and lower energetic charge, were observed in hearts preserved with less effective solutions.
Conclusions:
- Extracellular cardioplegic solutions generally offer better cardiac preservation than intracellular solutions.
- Celsior and LYPS solutions demonstrated comparable and superior efficacy in preserving left ventricular function.
- Calcium content in extracellular solutions may contribute to improved preservation quality.
Background:
Reports conflict on the benefits of preservative solutions. We investigated the efficacy of the most widely used cardioplegic solutions by comparing extracellular solutions such as Celsior solution, St. Thomas Hospital solutions 1 and 2 (STH-1, STH-2), the modified University of Wisconsin solution (UW-1), Lyon Preservation solution (LYPS) from our laboratory, and intracellular solutions such as standard University of Wisconsin solution (UW), Bretschneider solution (HTK), Stanford solution (STF), and Euro-Collins solution (EC).
Methods:
Male rats (n = 110) were randomized into 11 groups: LYPS, Celsior, STH-1, STH-2, UW-1, UW, HTK, STF, EC, and normal saline solution groups, and a control group. All hearts, except controls, were preserved by cold storage (8 hours at 4 degrees C) in the various solutions. We used an isolated non-working-heart model and biopsy specimens to assess heart preservation (n = 5/group).
Results:
Hearts stored in the EC and saline solutions had poor left ventricular developed pressure (LVDP) x heart rate (HR) (1,407.5 +/- 154 and 1,390 +/- 439 mm Hg/mn, respectively). In contrast, hearts stored in LYPS and Celsior had a LVDP x HR close to control hearts (31,349 +/- 1,847, 27,620 +/- 1,207, and 36,627 +/- 1,322 mm Hg/mn, respectively), whereas hearts stored in STH-1, STH-2, UW-1, UW, HTK, and STF had intermediate functional response (14,278 +/- 2,176, 12,402 +/- 1,571, 11,428 +/- 1,629, 11,603 +/- 2,521, 7,045 +/- 537, and 7,086 +/- 1,206 mm Hg/mn, respectively). Hearts preserved with STH-2, UW, HTK, STF, EC, and saline solution showed significantly increased release of creatine kinase and lactate dehydrogenase than did control hearts or hearts preserved in Celsior, LYPS, STH-1, and UW-1. The energetic charge (EC = [(0.5 adenosine diphosphate + adenosine triphosphate) / (adenosine triphosphate + adenosine diphosphate + adenosine monophosphate)]) in STH-2, UW, HTK, STF, EC, and saline groups was significantly lower (p < 0.05) than in the other groups.
Conclusion:
Extracellular-type solutions provided better preservation than did intracellular-type solutions. However, UW and UW-1 (intracellular- and extracellular-type solutions) provided equivalent preservation of cardiac function. Preservation quality may be attributed to calcium, often added to extracellular solutions. Among extracellular solutions, Celsior and LYPS solution showed comparable efficacy on left ventricular function and seemed to offer better preservation than the other solutions tested in this study.
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