LONG-TERM HEART PRESERVATION BY THE COMBINED METHOD OF SIMPLE IMMERSION AND CORONARY PERFUSION

Background: The combined method of cold storage and coronary perfusion for prolonged preservation of donor hearts was' evaluated through pre servation and transplantation with the use of 10 pairs of adult mongre l dogs. Methods: In situ initial flush for cooling and coronary vascul ar washout was performed with a University of Wisconsin solution. The heart was then removed and immersed into a cold (4 degrees C) Universi ty of Wisconsin solution. After 12-hour cold storage, 1-hour preservat ion was added by coronary perfusion using a 4 degrees C oxygenated Uni versity of Wisconsin solution. High-energy phosphate (phosphocreatine, beta-adenosine triphosphate) and inorganic phosphate were measured by P-31-nuclear magnetic resonance spectroscopy at 0-hour cold storage, 12-hour cold storage, and immediately after coronary perfusion. Result s: Phosphocreatine and beta-adenosine triphosphate decreased to 12.1% +/- 24.2% (mean +/- standard deviation), 37.4% +/- 25.0%, respectively , after 12-hour cold storage, and significantly increased to 94.0% +/- 48.7% (p +/- 0.001), 48.8% +/- 25.8% (p < 0.05), respectively after 1 -hour coronary perfusion. Disorder of nuclear arrangement and edema of muscular cells, which were observed after cold storage, were histolog ically restored after 1-hour coronary perfusion. After transplantation of preserved grafts, left ventricular pressure and left ventricular r ate of pressure rise were evaluated in the graft with 12-hour cold sto rage only (group A) and in the graft with 12-hour cold storage and 1-h our coronary perfusion (group B). Left ventricular pressure 2 hours af ter transplantation in group B recovered to 76.1% significantly (P < 0 .01), compared with 51.9% in group A. Significantly higher values of l eft ventricular rate of pressure rise 2 hours after transplantation wa s observed in group B (83.0% +/- 12.7%) compared with group A (68.2% /- 12.5%). Conclusions: These results indicate that the combined metho d of cold storage and coronary perfusion may be effective for myocardi al protection during long-term preservation.