NEW SOLUTION FOR PROLONGED MYOCARDIAL PRESERVATION FOR TRANSPLANTATION

Background: A solution for prolonged cold storage of the heart has bee n developed. The Jerusalem-Cape Town Solution (JCT) is an ''intracellu lar'' type cardioplegic solution and is formulated to (1) minimize hyp othermic-induced cell swelling, (2) diminish intracellular acidosis, ( 3) prevent the expansion of the interstitial space during the reperfus ion, (4) protect against oxygen free radical injury during early reper fusion, and (5) provide substrates for regenerating high-energy phosph ates. Methods: With a Langendorff model, rat hearts were subjected to 15 minutes of perfusion with Krebs-Henseleit, 10 minutes of cardiopleg ic infusion and 20 hours of cold storage (5 degrees to 6 degrees C). H earts were reperfused for 60 minutes and hemodynamic recovery was asse ssed. The hearts were assigned to three groups (eight hearts in each), according to the cardioplegic solution used: group 1, JCT; group 2, B retschneider's HTK cardioplegic solution; and group 3 University of Wi sconsin cold storage solution. Results: After 60 minutes of reperfusio n, the recovery of the coronary artery flow in group 1 (JCT) was signi ficantly better than in group 2, and slightly better than in group 3 ( 64% +/- 8.9%, 47.2% +/- 11.6%, 52.5% +/- 19.9%, mean +/- SD, respectiv ely; group 1 versus group 2, p < 0.01). The recovery of the left ventr icular developed pressure (LVDP) was significantly better in group 1 c ompared with group 2 and group 3 (60.2% +/- 14.5%, 41.1% +/- 12.6% and 36.5% +/- 10.1%, respectively; p < 0.01). The recovery of the heart c ontractility expressed by the product of LVDP and the heart rate (LVDP x heart rate) was significantly higher in group 1 than in group 2 and group 3 (47.5% +/- 3.4%, 23.6% +/- 9.6%, and 28.7% +/- 8.3%, respecti vely, p < 0.001). In hearts stored for 12 hours in JCT or HTK, the rec overy of the heart contractility did not differ significantly (73.4% /- 12.7% or 70.8% +/- 30.8%, respectively). Modified reperfusion aimed to improve postischemic heart recovery did not bring significant chan ges in cardiac mechanical function but resulted in an increase in post ischemic coronary artery flow recovery in hearts reperfused with amino acid-enriched buffer. Conclusions: The JCT solution is effective (as well as HTK) in preserving the ischemic hearts for up to 12 hours. It is superior to HTK or University of Wisconsin solution at 20 hours of isolated ischemic storage.