Results of a study of the effectiveness of direct coronary oxygen persufflation as a donor heart conditioning method

M. Zhulkov, D. Sirota, I. Zykov, A. Sabetov, K. Agaeva, А. G. Makaev, D. Osintsev, A. P. Nadeev, V. Kliver, E. Kliver, A. Volkov, A. Tarkova, А. V. Fomichev, A. Chernyavsky
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引用次数: 1

Abstract

Objective: to evaluate the technical feasibility as well as functional, metabolic and structural integrity of donor heart myocardium after 4 hours of direct intracoronary oxygen persufflation in an experiment.Materials and methods. Mini-pig siblings aged 3 months with a body weight of23-36 kg were used as the experimental model. In the control group (n = 8), donor hearts were cold preserved by injecting 2 liters of Bretschneider cardioplegic solution (Custodiol®, Germany, HTK) into the aortic root. In the experimental group (n = 8), modified HTK solution (with 40 mg/L hyaluronidase added) was used to initiate cardioplegia, then moistened carbogen (95% O2, 5% CO2) was injected into the ascending aorta, maintaining 40-45 mm Hg aortic root pressure. The hearts were stored in an mHTK solution at 0-4 °С. After 3 hours of donor heart preservation, orthotopic heart transplantation (OHTx) was performed. In the post-transplant period, we studied central hemodynamic parameters, myocardial oxygen consumption, level of myocardial ischemia markers (troponin I, Tnl; creatine phosphokinase-MB, CPK-MB; lactate dehydrogenase, LDH), and histological signs of structural cellular injury.Results. Sixteen OHTx surgeries were performed during the study. At 120 minutes after restoration of spontaneous cardiac activity, cardiac output was 2.99 [4.85; 3.17] L/min and 2.48 [2.04; 2.92] L/min (p > 0.05) in the control and experimental groups, respectively. Changes in LDH, TnI and lactate levels in the blood flowing from the coronary sinus were significantly higher in the early reperfusion period. However, there was no statistically significant difference between the groups (p > 0.05). Myocardial oxygen consumption in the control and experimental groups was 8.2 [7.35; 9.35] ml-O2/min/100 g and 7.7 [6.75; 10.12] ml-O2/min/100 g, respectively (p > 0.05). Morphological examinations also showed no significant myocardial ischemia injury in the persufflation group compared to the control group.Conclusion. The experiment showed the technical feasibility and safety of direct intracoronary oxygen persufflation for 4 hours at the ex vivo donor heart conditioning stage. At the same time, experimental data showed no significant advantages of coronary persufflation over the standard protocol of cold preservation of donor heart with Bretschneider cardioplegic solution.
直接冠状动脉氧灌注作为供体心脏调节方法的有效性研究结果
目的:评价直接冠状动脉内氧灌注4小时后供心肌的技术可行性及功能、代谢和结构完整性。材料和方法。以3月龄、体重23-36 kg的迷你猪兄弟姐妹为实验模型。对照组(n = 8)将2升Bretschneider心脏截瘫液(Custodiol®,Germany, HTK)注入主动脉根部进行冷保存。实验组(n = 8)采用改良HTK溶液(添加40 mg/L透明质酸酶)启动心脏骤停,然后在升主动脉内注入湿润碳(95% O2, 5% CO2),维持主动脉根压40-45 mm Hg。心脏保存在0-4°С的mHTK溶液中。供体心脏保存3小时后,进行原位心脏移植(OHTx)。在移植后,我们研究了中心血流动力学参数、心肌耗氧量、心肌缺血标志物(肌钙蛋白I, Tnl;肌酸磷酸激酶- mb;乳酸脱氢酶(LDH)和结构性细胞损伤的组织学征象。研究期间共进行16例OHTx手术。恢复心脏自发活动后120分钟,心输出量为2.99 [4.85;3.17] L/min和2.48 [2.04;对照组和实验组分别为2.92 L/min (p < 0.05)。冠状窦血流中LDH、TnI和乳酸水平的变化在再灌注早期明显升高。但两组间比较差异无统计学意义(p < 0.05)。对照组和实验组心肌耗氧量分别为8.2 [7.35];9.35] ml-O2/min/100 g和7.7 [6.75;10.12] ml-O2/min/100 g (p < 0.05)。形态学检查显示,与对照组相比,灌注组未见明显心肌缺血损伤。本实验表明在离体供体心脏调节阶段直接冠状动脉内氧灌注4小时的技术可行性和安全性。与此同时,实验数据显示,与供体心脏用Bretschneider停搏液冷保存的标准方案相比,冠状动脉灌注没有明显的优势。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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