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Distant heart procurement. Impacts of storage solution composition on cardiac performance following transplantation
B Hausen1, H G Fieguth, H J Schäfers
1Abteilung für Herz-, Thorax- und Gefässchirurgie, Medizinische Hochschule, Hannover, Federal Republic of Germany.
Insights
Euro-Collins
Area of Science:
- Cardiology
- Transplantation Medicine
- Biomedical Engineering
Background:
- Optimal storage solutions for distant heart procurement are not well-defined, particularly regarding electrolyte concentrations.
- Heart transplantation requires effective preservation solutions to maintain graft viability during transport.
- Existing storage solutions may have limitations impacting post-transplant cardiac function.
Purpose of the Study:
- To compare the efficacy of Euro-Collins' solution (ECS) versus Ringer's solution (RS) for preserving donor hearts for transplantation.
- To evaluate the impact of different storage solutions on early post-operative cardiac function and support requirements.
- To determine if ECS or RS offers superior outcomes in terms of graft performance and patient recovery.
Main Methods:
- A randomized study involving 18 heart transplant patients between December 1986 and April 1987.
- Donor hearts were preserved using either ECS or RS at 4°C after cardioplegic arrest (St. Thomas' solution).
- Post-operative monitoring included hemodynamic parameters (pressures, cardiac output), inotropic support needs, and cardiac rhythm for the first 24 hours.
Main Results:
- No significant differences in graft ischemia time or baseline hemodynamic parameters (MAP, RAP, LAP, CO) between ECS and RS groups.
- Significantly lower epinephrine requirements (P < 0.05) in the ECS group compared to the RS group for maintaining mean arterial pressure.
- Higher left cardiac work index (P < 0.05) and reduced need for cardiac pacing (P < 0.05) in patients receiving hearts preserved with ECS.
Conclusions:
- Euro-Collins' solution (ECS) appears to provide superior myocardial protection compared to Ringer's solution (RS) in early post-heart transplant recovery.
- ECS may reduce the need for inotropic support and cardiac pacing, suggesting improved graft function.
- Further research into optimal electrolyte compositions for heart preservation solutions is warranted.
Abstract:
In distant heart procurement, optimal storage conditions remain to be defined, especially with respect to the electrolytic concentrations of storage solutions. Between December 1986 and April 1987, heart transplants were carried out in 18 patients. After cardioplegic arrest (St. Thomas), the hearts were randomly stored in either Euro-Collins' solution (ECS; n = 9) or Ringer's solution (RS; n = 9) at 4 degrees C. For the first 24 h postsurgery, atrial pressures (LAP, RAP), systemic (MAP) and pulmonary pressures (PAP), and cardiac output (CO) were monitored. In addition, catecholamine and nitroglycerin requirements as well as the type of cardiac rhythm were documented. There was no significant difference between the groups in terms of the period of graft ischemia (ECS, 162 +/- 28 min; RS, 141 +/- 47 min); the MAP, RAP, LAP, and CO were also similar in both groups. The total amount of epinephrine needed to maintain the MAP between 60 and 80 mm Hg was 10.5 mg/24 h +/- 4.1 mg in ECS compared with 19.9 mg/24 h +/- 12 mg in RS (P less than 0.05). Despite less inotropic support, the left cardiac work index was considerably higher in the ECS group (P less than 0.05). In the first few postoperative hours, 8/9 RS patients needed either atrial (n = 4) or ventricular pacing (n = 4) for a heart rate of 90-100 beats/min (bpm), whereas only three ECS patients required atrial pacing (P less than 0.05). All other ECS hearts showed a spontaneous sinus rhythm.(ABSTRACT TRUNCATED AT 250 WORDS)