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Eur J Cardiothorac Surg 2007;31:214-221. doi:10.1016/j.ejcts.2006.11.029
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Comparing the ultrastructural effects of two different cardiac preparation- and perfusion-techniques in a porcine model of extracorporal long-term preservation

Heike Aupperlea,*,1, Jens Garbadeb,1, Chris Ullmannb, Katja Schneiderb, Christian Krautzb, Stefan Dheinb, Jan Fritz Gummertb, Heinz-Adolf Schoona

a Institute of Pathology, Faculty of Veterinary Medicine, University of Leipzig, An den Tierkliniken 33, 04103 Leipzig, Germany
b Department of Cardiac Surgery, Heart Center, University of Leipzig, Strümpell Str. 39, 04289 Leipzig, Germany

Received 20 August 2006; received in revised form 10 November 2006; accepted 20 November 2006.

* Corresponding author. Address: Institut für Veterinär Pathologie, Universität Leipzig, An den Tierkliniken 33, 04103 Leipzig, Germany. Tel.: +49 341 9738277; fax: +49 341 9738299. (Email: aupperle{at}rz.uni-leipzig.de).

Objective: In heart transplantation a well-preserved myocardial ultrastructure is an important precondition for functional regeneration. Aim of the study is to optimize the conditions in this new established model of extracorporeal cardiac perfusion. Methods: (I) In six pigs, hearts were arrested with Bretschneider Histidine-Tryptophan-Ketoglutarate cardioplegia and cold ischemia, explanted and connected to a circulating constant pressure Langendorff system (80–90 mmHg) and perfused with leukocyte depleted autologous blood. (II) Beating hearts of seven pigs were explanted and connected immediately to the Langendorff system (40–50 mmHg). Myocardial biopsies (n = 55) were taken in situ and during the following 12 h of reperfusion, and were prepared for electron microscopy. Results: Cardioplegia and hypothermia (group I) induced mitochondrial edema and myofibrillar degeneration in cardiomyocytes and severe endothelial edema. During 4 h of reperfusion, mitochondrial edema, myofibrillar, and sarcolemmal damages in cardiomyocytes increased. Moderate endothelial degeneration, interstitial edema, and bleedings appeared. In contrast, in group II after 6 h of reperfusion endothelia showed only mild alterations. Cardiomyocytes showed myofibrillary but not mitochondrial degeneration. Interstitial edema and bleedings were mild. Conclusion: Avoiding cardioplegia and hypothermia, and using lower perfusion pressure resulted in a better preservation of the ultrastructure in explanted hearts at the Langendorff system.

Key Words: Heart transplantation • Langendorff system • Ultrastructure • Pig






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Copyright © 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier. All rights reserved.