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Recipient hypertonic saline infusion prevents cardiac allograft dysfunction.

Roberto V P Ribeiro1, Mitesh V Badiwala1, Danny Ramzy2

  • 1Heart Transplant Program, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Division of Cardiovascular Surgery, University of Toronto, Toronto, Ontario, Canada.

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PubMed
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Hypertonic saline (HTS) pretreatment improved heart transplant outcomes by preserving graft function and reducing inflammation. This intervention limited endothelial and left ventricular dysfunction post-transplantation.

Keywords:
heart transplantationmyocardial ischemia/reperfusion injurymyocardial protection

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Area of Science:

  • Cardiovascular Surgery
  • Immunology
  • Nephrology

Background:

  • Hypertonic saline (HTS) exhibits significant immune and vascular effects.
  • Pretreatment with HTS in heart transplantation recipients may mitigate post-transplant dysfunction.

Purpose of the Study:

  • To evaluate the impact of recipient pretreatment with HTS on allograft function in a porcine heart transplantation model.
  • To test the hypothesis that HTS infusion limits endothelial and left ventricular (LV) dysfunction post-transplantation.

Main Methods:

  • Porcine heart transplants were performed after 6 hours of cold ischemic storage.
  • Recipients were randomized to receive HTS (7.5% NaCl) or no treatment before cardiopulmonary bypass (CPB).
  • Endothelial-dependent (Edep) and -independent (Eind) vasorelaxation, LV performance (pressure-volume loops), and inflammatory markers (IL-2, IL-6, TNF-α) were assessed.

Main Results:

  • HTS-treated animals showed improved weaning from CPB (8/8 vs 2/8) and enhanced LV functional recovery (preload recruitable stroke work: 65±10% vs 27±10%; end-systolic elastance: 55±7% vs 37±4%).
  • HTS improved endothelial-dependent (Emax: 56±5% vs 37±7%) and -independent (Emax: 77±6% vs 52±4%) vasorelaxation.
  • HTS attenuated pulmonary and cardiac inflammatory responses, reducing IL-2, IL-6, and TNF-α expression.

Conclusions:

  • Recipient HTS pretreatment preserves allograft vasomotor and LV function.
  • HTS therapy effectively limits CPB-induced injury and associated inflammation.
  • HTS represents a potential novel recipient intervention to prevent graft dysfunction after heart transplantation.