Improved preservation of coronary endothelial function with celsior compared with blood and crystalloid solutions in heart transplantation

Background: Endothelial injury from preservation solutions has been implica ted in acute coronary vasospasm and pathologic activation of the endotheliu m, which can contribute to the development of graft coronary vasculopathy a fter heart transplantation. Preservation solutions with a powerful antioxid ant capacity may decrease the occurrence of these complications. Materials and Methods: This study was designed to evaluate the effect of Ce lsior tan anti-oxidant solution specifically designed for cardiac preservat ion) in a model of heart preservation (4 hours at 4 degreesC to reproduce t he situation encountered in clinical heart transplantation) compared two co mmonly used cardioplegic and preservation strategies on coronary endothelia l function. Endothelium-dependent relaxation of normal porcine epicardial c oronary arteries to serotonin (5-HT, an agonist that activates 5-HT1d recep tors coupled to Gi proteins) and bradykinin (BK, which activates B2 recepto rs coupled to Gq proteins) was studied in standard organ chamber experiment s in the following groups: a control group was submitted to immediate excis ion without cardioplegia and preserved in saline solution (0.9% NaCl) for 4 hours (Group 1); two groups had cardioplegia induced with a crystalloid so lution and were stored for 4 hours in saline (Group 2) or 4 hours in Celsio r solution (Group 3); and two groups had cardioplegia induced with normothe rmic blood cardioplegia and were stored for 4 hours in the saline (Group 4) , or 4 hours in Celsior solution (Group 5). Finally, two groups underwent c ardioplegia with Celsior and were stored for 4 hours in saline (Group 6), o r 4 hours in the Celsior solution (Group 7). All cardioplegia solutions wer e at 4 degrees C (except blood cardioplegia at 37 degrees C) and all preser vations solutions were at 4 degrees C. Results: Endothelium-dependent relaxations to serotonin were significantly decreased in all groups except the Celsior + Celsior group compared with th e control group. There were no significant differences in relaxation to bra dykinin except in one group. Use of the Celsior solution for induction of c ardioplegia and storage better preserved endothelium-dependent G-protein-me diated relaxation compared with the other arrest and preservation strategie s. Conclusions: The observed effect may be associated with an improvement in b oth short- and long-term outcome in heart transplantation, especially becau se these alterations may be further compounded by reperfusion.