Two-decade analysis of cardiac storage for transplantation

Objective: Cardiac storage solutions and methods remain unstandardized. We have surveyed the literature to establish how the subject has progressed. a ddressing models of preservation and measures Of Outcome. Since a lot of th e literature on cardiac storage is generated in the laboratory. we were par ticularly interested to evaluate to what extent bench work finds its way in to and clinical practice. The discussion focuses in addition to new areas o f research and introduces the concept of integrated organ preservation. Met hods: Five representative journals (J Thorac Cardiovasc Surg, Circulation, J Heart Lung Transplant, Eur J Cardio-thorac Surg and Ann Thorac Surg) were searched by hand for papers published between 1980-1999. All laboratory an imal experimental and clinical studies focused on prolonged cardiac preserv ation and storage were selected. Results: Two hundred and forty-nine public ations were identified using preset criteria. Of these, 196 (79%) were Stud ies performed in animal models and 10 (4%) were experiments carried out on animal tissue. One hundred and five experiments (42% of all studies) were p erformed in small animals. The most common animal model was of ischemia fol lowed by ex vivo reperfusion (121 studies, 49% of publications). The measur es of outcome were classified as biochemical, functional, morphologic and e ndothelial: the majority of studies had one (48%) or two (40%) end-points. Twenty-five studies (10%) had endothelial measures of outcome. alone or in combination with other types of outcomes. Human clinical work was represent ed by 34 (14%) studies of clinical transplantation and nine (4%) experiment s on human tissue only. There were five randomized clinical trials, represe nting 2% of all papers and 15% of all clinical research. Conclusion: In con clusion. most of the surgical publications on prolonged cardiac preservatio n result from animal research. Small animal models of ex vivo ischemia and reperfusion are predominant. (C) 2001 Elsevier Science BN. All rights reser ved.