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Eur J Cardiothorac Surg 2000;17:71-76
© 2000 Elsevier Science NL

Coronary oxygen persufflation combined with HTK cardioplegia prolongs the preservation time in heart transplantation

^a Department of Cardiothoracic Surgery, University of Cologne, Joseph Stelzmann Strasse 9, D-50924 Cologne, Germany
^b Institute for Experimental Medicine, University of Cologne, Joseph Stelzmann Strasse 9, D-50924 Cologne, Germany
^c Institute for Clinical Chemistry, University of Cologne, Joseph Stelzmann Strasse 9, D-50924 Cologne, Germany

Corresponding author. Tel.: +49-221-478-6043/478-5830; fax: +49-221-478-5906
e-mail: ferdinand.kuhn-regnier{at}medizin.uni-koeln.de

Background: One of the most restricting factors remaining in heart transplantation is the limited myocardial ischemia time. A new approach towards the prolongation of this time is the combination of primary cardioplegic arrest followed by continuous coronary oxygen persufflation (COP) with gaseous oxygen. Methods: This technique was applied in pig hearts, which we transplanted orthotopically after cardioplegic arrest by original (n=5) and modified (addition of hyaluronidase: n=11) Bretschneider HTK solution and 14 h of hypothermic preservation. Depending on the different preservation techniques, we created four groups: (1), original HTK (HTK), n=5; (2), modified HTK (mHTK), n=5; (3), modified HTK solution plus COP (mHTK+COP), n=6; and (4), as a control five hearts were transplanted after cardioplegic arrest by the original HTK solution and a cold ischemia time of 3 h comparable to clinical routine procedure. Results: After 14 h of preservation and orthotopic transplantation, cardiac functional recovery in mHTK+COP hearts was similar to control hearts, and improved compared to hearts of both other groups. Hemodynamics were significantly better in hearts preserved by mHTK+COP and in the control group compared to the HTK-hearts (P<0.05), not significant compared to mHTK hearts (dp/dt_max in % of preoperative±standard error of mean (SEM): mHTK+COP, 85±9; control, 85±10.5; mHTK, 59±14; HTK, 50±4). The cardiac output (CO) in % of preoperative was: mHTK+COP, 68±5.4; control, 64±4; mHTK, 44±2.7; HTK, 25±11. The ATP of left ventricular myocardium in mHTK+COP hearts at 14.7±1 µmol/g dry weight (DW) and in the control at 14.59±1.8 was higher compared to that in mHTK at 12.2±2.8 (P is non-significant (n.s.) versus mHTK+COP and control) and in HTK-hearts at 7.0±0.5 (P<0.05 versus mHTK+COP and control). CK–MB in percent of CK showed no increase in either group. Conclusions: These data show that COP combined with a mHTK solution represents a potential alternative to complement currently used cold storage techniques for prolonged preservation periods.

Key Words: Coronary oxygen persufflation • Heart transplantation • Crystalloid cardioplegia • Prolonged heart preservation • Hypothermia

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