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Eur J Cardiothorac Surg 1998;14:607-614
© 1998 Elsevier Science NL

Orthotopic transplantation of pig hearts harvested after 30 min of normothermic ischemia: controlled reperfusion with blood cardioplegia containing the Na⁺-H⁺-exchange inhibitor HOE 642¹

^a Department of Cardiovascular Surgery, Albert-Ludwigs-University Medical Center, Hugstetter Str. 55, D-79106 Freiburg, Germany
^b Department of Cardiovascular Surgery, Jikei University Medical Center, Tokyo, Japan
^c Department of Surgical Research, Albert-Ludwigs-University Medical Center, Freiburg, Germany
^d Department of Thoracic Surgery, Sapporo University Medical Center, Sapporo, Japan

Received 15 April 1998; received in revised form 5 September 1998; accepted 8 September 1998.

Corresponding author. Department of Cardiovascular Surgery, Albert-Ludwigs-University, Freiburg, Germany. Tel.: +49-761-270-2818; fax: +49-761-270-2550

Objectives: The aim of our study was to develop a surgical technique for a successful transplantation of hearts harvested after 30 min of normothermic ischemia without donor pretreatment. Successful transplantation of ischemic compromised hearts could help to expand the severely limited donor pool. We used the pig model because this species is very susceptible to myocardial ischemia. Na⁺-H⁺-exchange (NHE) inhibitors have shown excellent protective properties in several in vitro and in vivo models of myocardial ischemia and reperfusion. Methods: In group I (n=12) hearts were harvested after 30 min of normothermic ischemia following cardiac arrest induced by exsanguination. Hearts were perfused with warm blood cardioplegia and transplanted orthotopically. In group II (n=9) controlled reperfusion with cold leucocyte-depleted blood cardioplegia was performed after 30 min of normothermic ischemia. In group III (n=8) the same procedure was performed as in group II but blood cardioplegia contained 1 mmol/l HOE 642. Results: In group I massive myocardial oedema was observed and none of the animals could be weaned from cardiopulmonary bypass (CPB). In contrast, all animals in groups II and III could be weaned from CPB with low dose inotropic support. In groups II and III the contractility of the hearts, expressed as maximal left and right ventricular stroke work index was significantly impaired after transplantation as compared with the preoperative value. Supplementation of blood cardioplegia with HOE 642 resulted in a significantly better recovery of the LVSWImax (Group II vs. III). Conclusions: Successful transplantation of pig hearts is possible after 30 min of normothermic ischemia without donor pretreatment if a controlled reperfusion with cold leucocyte-depleted blood cardioplegia is performed. HOE 642 given during reperfusion only improves posttransplant left ventricular function.

Key Words: Heart transplantation • Myocardial preservation • Non-heart-beating donors • Controlled reperfusion • Na⁺-H⁺-exchange-inhibitors

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