HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Serban C. Stoica Andrew N. Redington Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Stoica, S. C. Articles by Large, S. R. Search for Related Content PubMed PubMed Citation Articles by Stoica, S. C. Articles by Large, S. R. Related Collections Cardiac - physiology Myocardial protection Transplantation - heart

Eur J Cardiothorac Surg 2003;23:503-512
© 2003 Elsevier Science NL

The energy metabolism in the right and left ventricles of human donor hearts across transplantation

^a Department of Transplantation, Papworth Hospital, Cambridge CB3 8RE, UK
^b Department of Cardiology, Hospital for Sick Children, Toronto, Canada M5G 1X8
^c Department of Clinical Biochemistry, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK

Received 3 September 2002; received in revised form 29 December 2002; accepted 7 January 2003.

^* Corresponding author. Tel.: +44-1480-830-541; fax: +44-1480-364-334
e-mail: stephenrlarge{at}hotmail.com

Objective: Brain death appears to predominantly affect the right ventricle (RV) and right ventricular failure is a common complication of clinical cardiac transplantation. It is not clear to what extent myocardial energy stores are affected in the operative sequence. We aimed to describe the time-dependent variation in high energy phosphate (HEP) metabolism of the two ventricles, and the relationship with endothelial activation and postoperative functional recovery. Methods: Fifty-two human donors had serial biopsies from the RV and the left ventricle (LV) at (1) initial evaluation, (2) after haemodynamic optimisation, (3) end of cold ischaemia, (4) end of warm ischaemia, (5) reperfusion, and (6) at 1 week postoperatively. HEP was measured by chemiluminescence in biopsies 1–5 and adhesion molecules (P-selectin, E-selectin, VCAM-1) and thrombomodulin were analysed by immunohistochemistry in biopsies 5–6. Seventeen donors and five recipients had RV intraoperative pressure–volume recordings by a conductance catheter. Six patients served as live controls. Results: Brain death did not affect HEP metabolism quantitatively. There was no difference between the RV and LV at any time point, but significant time-dependent changes were observed. The RV was prone to HEP depletion at retrieval, with ATP/ADP falling from 3.89 to 3.13, but recovered during cold ischaemia. During warm ischaemia the ATP/ADP ratio fell by approximately 50%, from 5.48 for the RV and 4.26 for the LV, with partial recovery at reperfusion (P<0.005). Hearts with impaired function in the recipient showed marked variations in HEP levels at reperfusion, and those organs with RV dysfunction failed to replenish their energy stores. However, these organs were not different from normally functioning allografts in terms of endothelial activation and clinical risk factors. There was poor correlation between pressure–volume and HEP data in either donor or recipient studies. Hearts followed-up with HEP and pressure–volume studies showed improvement in the recipient, despite functioning against a higher pulmonary vascular resistance. Conclusions: HEP are preserved over a wide range of contractile performance in the donor heart, with no metabolic difference between the two ventricles. No correlation with endothelial activation was seen either. Preservation efforts should be directed to the vulnerable periods of implantation and reperfusion.

Key Words: Heart transplantation • Brain death • Endothelium • Energy stores • Myocardial contractility

This article has been cited by other articles:

				H. Aupperle, J. Garbade, C. Ullmann, K. Schneider, C. Krautz, S. Dhein, J. F. Gummert, and H.-A. Schoon Comparing the ultrastructural effects of two different cardiac preparation- and perfusion-techniques in a porcine model of extracorporal long-term preservation Eur. J. Cardiothorac. Surg., February 1, 2007; 31(2): 214 - 221. [Abstract] [Full Text] [PDF]

				S. C. Stoica, D. K. Satchithananda, P. A. White, L. Sharples, J. Parameshwar, A. N. Redington, and S. R. Large Brain death leads to abnormal contractile properties of the human donor right ventricle J. Thorac. Cardiovasc. Surg., July 1, 2006; 132(1): 116 - 123. [Abstract] [Full Text] [PDF]

				T. Caus, F. Kober, A. Mouly-Bandini, A. Riberi, D. R. Metras, P. J. Cozzone, and M. Bernard 31P MRS of heart grafts provides metabolic markers of early dysfunction Eur. J. Cardiothorac. Surg., October 1, 2005; 28(4): 576 - 580. [Abstract] [Full Text] [PDF]

				S. C. Stoica, D. K. Satchithananda, C. Atkinson, S. Charman, M. Goddard, and S. R. Large Heat shock protein, inducible nitric oxide synthase and apoptotic markers in the acute phase of human cardiac transplantation Eur. J. Cardiothorac. Surg., December 1, 2003; 24(6): 932 - 939. [Abstract] [Full Text] [PDF]