A CLINICAL-TRIAL COMPARING UNIVERSITY-OF-WISCONSIN SOLUTION AND COLD CARDIOPLEGIC SOLUTION WITH LOAD-INDEPENDENT MECHANICAL PARAMETERS

To evaluate the efficacy of University of Wisconsin solution for clini cal heart transplantation, load-independent parameters were used to as sess left ventricular function after transplantation. Donor hearts wer e arrested with and stored in buffered cold cardioplegic solution for control (n = 5) and University of Wisconsin solution for the experimen tal group (n = 5). Orthotopic transplantations were performed in a rou tine manner. Mean donor age (cardioplegic solution, 28 +/- 5.2 years; University of Wisconsin solution, 28 +/- 5.1 years) and ischemic times (cardioplegic solution, 181 +/- 27 minutes; University of Wisconsin s olution, 224 +/- 23 minutes) were similar. Two hours after reperfusion of the heart, transesophageal echocardiography was used to image the left ventricle at the mid-papillary muscle level, and a high-fidelity catheter-tipped manometer was placed in the left ventricle to record l eft ventricular pressure simultaneously. These images were digitized d uring apneic baseline conditions and during an acute reduction in prel oad from inferior vena caval occlusion. The left ventricular cross-sec tional areas were measured and matched with left ventricular pressure from the catheter-tipped manometer to reveal pressure-area relationshi ps. The baseline parameters fractional area change and stroke force we re calculated. End-systolic elastance, the slope of end-systolic press ure-area relationship and preload recruitable stroke force, the slope of stroke force versus end-diastolic area were calculated from the inf erior vena cava occlusion measurements. There was no significant diffe rence in fractional area change (cardioplegic solution, 53%; Universit y of Wisconsin solution, 46%), stroke force (cardioplegic solution, 44 2 mm Hg/cm2; University of Wisconsin solution, 485 mm Hg/cm2), end-sys tolic elastance (cardioplegic solution, 6.9 mm Hg/cm2; University of W isconsin solution, 7.9 mm Hg/cm2), preload recruitable stroke force (c ardioplegic solution, 56.4 mm Hg; University of Wisconsin solution, 65 .3 mm Hg). We conclude that University of Wisconsin solution has no su perior effect on cardiac function after clinically relevant ischemic t imes.