EXPERIMENTAL EVALUATION OF CELSIOR((R)), A NEW HEART PRESERVATION SOLUTION

An original heart preservation solution (Celsior) has been developed, the formulation of which has been designed to fulfil two major objecti ves: (1) to combine the general principles of hypothermic organ preser vation with those specific for the myocardium, and (2) to offer the po ssibility of being used not only as a storage medium but also as a per fusion fluid during initial donor heart arrest, poststorage graft reim plantation and early reperfusion. The major principles addressed by th e Celsior formulation include (1) prevention of cell swelling (by mann itol and lactobionate), (2) prevention of oxygen-derived free radical injury (by reduced glutathione, histidine and mannitol), and (3) preve ntion of contracture by enhancement of energy production (glutamate) a nd limitation of calcium overload (high magnesium content, slight degr ee of acidosis). Two experimental preparations were used: The isolated isovolumic buffer-perfused rat heart model and the heterotopic rabbit heart transplantation model. In isolated heart experiments, hearts we re arrested with and stored in Celsior for 5 h at 4-degrees-C and subs equently reperfused for 1 h. A similar protocol was used in the transp lantation experiments except that the total ischemic time was approxim ately 1 1/2 h longer (corresponding to 6 h of storage followed by the 25 additional minutes of cold ischemia required for graft implantation ). In both models, the results were primarily assessed on isovolumic m easurements of left ventricular diastolic pressure, developed pressure and peak positive rate of the rise of the left ventricular pressure ( dP/dt), and compared with those obtained in control hearts arrested wi th and stored in St Thomas' Hospital cardioplegic solution No 2 under similar experimental conditions. The isolated rat heart experiments sh ow that Celsior-preserved hearts incurred significantly smaller losses of compliance after ischemia than hearts exposed to St Thomas' Hospit al solution whereas they demonstrated significantly higher values of c ontractile indices throughout the period of reperfusion. Qualitatively similar patterns of recovery were seen in the rabbit transplantation experiments. We conclude that the functional preservation of cardiople gically arrested cold-stored cardiac allografts can be improved by the ir exposure to a single solution, the formulation of which combines th e major protective features of cardioplegic perfusates with those of o rgan storage media.