Prolonged neonatal myocardial preservation with a highly buffered low-calcium solution

Area of Science:

• Cardiology
• Neonatal Medicine
• Organ Preservation

Background:

• Myocardial preservation methods in neonates are debated.
• The University of Wisconsin solution is a standard but may have limitations in neonatal hearts.

Purpose of the Study:

• To compare a novel preservation solution promoting anaerobic glycolysis with the modified University of Wisconsin solution for neonatal heart preservation.
• To evaluate the impact of histidine and glucose-insulin on myocardial function and vascular integrity post-ischemia.

Main Methods:

• Neonatal piglet hearts (3-5 days old) were preserved using either modified University of Wisconsin solution or a histidine-glucose-insulin solution.
• Hearts underwent 20 hours of hypothermic global ischemia (4°C).
• Post-ischemic function was assessed using an isovolumic Langendorff preparation with erythrocyte-enhanced perfusate.

Main Results:

• The histidine-glucose-insulin solution group showed significantly greater left ventricular developed pressure and the first derivative of left ventricular pressure post-reperfusion.
• Myocardial oxygen consumption was markedly higher in the novel solution group.
• Acetylcholine induced coronary vasodilation in the novel solution group, unlike vasoconstriction in the University of Wisconsin solution group.

Conclusions:

• The novel preservation solution significantly enhances myocardial contractility, oxidative metabolism, and vascular function in neonatal hearts after prolonged hypothermic storage.
• Buffering protons and promoting anaerobic glycolysis are key mechanisms for improved neonatal myocardial preservation.
• This approach offers a promising alternative for neonatal heart preservation during transplantation or surgery.