Cardioplegia for transplantation: failure of extracellular solution compared with Stanford or UW solution

Crystalloid cardioplegia with an extracellular fluid formulation is widely used for donor heart protection. A survey of 109 transplant programs yielded 62 replies with 42% of respondents using variations of extracellular solution and 45% using the dextrose and mannitol-based Stanford solution. These two commonly used clinical solutions and University of Wisconsin (UW) solution, which has had success in clinical hepatic and renal transplantation, were compared in a canine model of cardiac transplantation. After antegrade hypothermic cardioplegic arrest, the experimental hearts were excised and stored at 4 degrees C for 6 hours (n = 29). An oxygenated, blood-primed isolated heart preparation was used for reperfusion. After a rest of 45 minutes, cardiac output was increased against constant afterload until a left atrial pressure of 15 mm Hg was reached. The maximum cardiac performance measured by cardiac index, minute work, and stroke work was highly significantly better with Stanford or UW solution protection than with the extracellular solutions (p less than 0.0001). Assuming a cardiac index of 50 mL.kg-1.min-1 is necessary for successful separation from cardiopulmonary bypass, only 1 of 14 extracellular and 15 of 15 Stanford and UW animals would have survived (p less than 0.0001). This study strongly suggests that extracellular cardioplegia is inferior for cardiac transplantation and that programs using this solution should reevaluate their method of myocardial protection for donor hearts.