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Myocardial function after preservation for 24 hours.

J M Burt, J G Copeland

    The Journal of Thoracic and Cardiovascular Surgery
    |August 1, 1986
    PubMed
    Summary
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    Donor heart preservation significantly impacts function, with longer preservation periods causing more damage than ischemia or reperfusion alone. This study quantifies damage during each stage of heart transplantation. Understanding these factors is crucial for improving organ viability.

    Area of Science:

    • Cardiovascular Surgery
    • Organ Transplantation
    • Cardiothoracic Research

    Background:

    • Heart transplantation involves multiple steps: cardioplegic arrest, cooling, ischemia, preservation, and reperfusion.
    • Each stage presents an opportunity for donor heart damage, potentially affecting post-transplant function.
    • Quantifying damage at each step is essential for optimizing preservation protocols.

    Purpose of the Study:

    • To quantify the degree of damage sustained by donor hearts during specific stages of the transplantation process.
    • To compare the functional recovery of hearts subjected to different preservation and ischemia durations and temperatures.
    • To identify the primary contributors to functional loss in transplanted hearts.

    Main Methods:

    • Rabbit hearts were subjected to various protocols simulating transplantation steps: cooling, cardioplegic arrest, ischemia (5°C or 25°C), and 24-hour preservation.

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  • Heart function was evaluated using Langendorff procedures, measuring contractile function (systolic pressure, dP/dt) and diastolic compliance.
  • Functional outcomes were compared between experimental groups and control hearts.

    • Main Results:

    • Cooling and reperfusion alone caused no functional loss, while cardioplegic arrest improved recovery time.
    • Ischemia at 5°C resulted in 95% contractile function recovery, and at 25°C, 89% recovery, with no diastolic changes.
    • 24-hour preservation led to 84% contractile function recovery, reduced by an additional hour of ischemia at 25°C (75% recovery), and compromised diastolic compliance.

    Conclusions:

    • The preservation period significantly contributes to donor heart functional decline, outweighing damage from ischemia and reperfusion.
    • Longer preservation times and ischemia, particularly at warmer temperatures, lead to greater loss of contractility and compliance.
    • These findings highlight the critical impact of preservation duration on heart graft viability and suggest areas for protocol improvement.