The Studies On Myocardial Protection Scheme And A Improved Cardiac Preservation Solution In Heart Transplantation

Objective:To design an improved donor heart preservation program on the basis of the clinical characteristic of the heart transplantation. Analyze the cardioprotective effects of the improved program and evaluate its clinical value.Methods:We summarized the181heart transplantation cases from January2008to December2011that used the improved program as the donor-heart preservation strategy. The organ preservation procedure was as follows:first, the donor hearts were arrested with aortic perfusion using St. Thomas’solution at4℃; then the donor hearts were perfused with2,000ml4℃HTK solution and preserved in icy saline. All the patients received orthotopic heart transplantation. Regular experimental biochemical and hemadenology tests as well as the bacteriology and virology tests were conducted.Results:The CPB, warm ischemia and cold ischemia time was185.9±52.6min,7.1±1.9min and285.7±114.5min, respectively. After releasing the aorta-clamp,59%of the patients recovered heart beat automatically. The16patients, who could not retrieve from CPB immediately after transplantation, turned to the extracorporeal membrane oxygenation (ECMO) support and retrieved from the mechanical support ultimately.177patients survived, and4patients died.Conclusion:Proper donor-heart protection strategy is indispensable for heart transplantation. The improved heart protective program can protect the organ heart properly. Objectives:To analyze the clinical effectiveness of the application of ECMO to the patients who suffered primary graft failure. To summarize the ECMO administration experience during heart transplantation.Methods:From January2008to December2011,181heart transplantation cases were studied retrospectively.16cases of them had received ECMO treatment after the transplantation. Data of the relevant parameters during ECMO, mechanism assistant duration and complications of the patients were collected. The lactic acid (LA) level at the onset and24hours of ECMO were measured. The dosages of dopamine and adrenergic pre and after24hours of ECMO were recorded.Results:Fourteen patients (87.5%) were successfully weaned from ECMO and13(81.3%) survived to hospital discharge. Among the16cases of ECMO,2cases abandoned therapy for no cardiac function promotion was obtained.1of them died of multiple organ failure (MOF) and chronic rejection were the main cause of death. All patients had received artery-vein (A-V) ECMO. The average level of LA at before,24hours and the end of ECMO were8.36±3.41、2.42±2.25±2.17mmol/L, respectively. The LA level was significantly decreased at the24hours and the end of ECMO, compared with pre ECMO period (P<0.05). The dosage of dopamine pre and after24hours of ECMO were7.38±3.42、5.29±1.93μg/min/kg, no significant differences were observed. However, after24hours of ECMO, the dosage of adrenergic significantly decreased0.17±0.11、0.02±0.03μg/min/kg,(P<0.05).Conclusions:ECMO is an effective mechanism support treatment for circulation and respiration failure. It could significantly decrease the early postoperative mortality rate of the patients who were at the terminal stage of cardiac diseases and received heart transplantation. Objective:The heart preservation solution is indispensable for the donor-heart preservation during transplantation. We combined "the cardiac protection and the coronary protection" together to intensify the isolated heart preservation effects. We used the isolated rat heart perfusion model to assess the hypothermic preservation effects of the newly designed solution.Methods:We randomly divided the male Wistar rats (n=15) to3groups as follow:Control, FW and HTK. The hearts, except the control group, were preserved by simplely immersion them for8hours at4℃in each solution. At the end of the storage period, the hearts were perfused immediately in the Langendorff model. Some indices of myocardial function were measured, every kind of myocardial enzymes were measured in the coronary effluent. Myocardium was reserved to observe the changes of myocardial ultra-structure to assess the quality of heart preservation.Results:The heart function of the experimental group decreased to a different degree. Group FW and HTK had a lower mean left ventricular developed pressure (LVDP)、 dp/dtmax、 dp/dtmin compared with the Control group (P<0.01). Group HTK showed better coronary flow (CF) compared to group FW (P<0.05). Group FW showed remarkably decreased release of every kind myocardial enzymes compared to group HTK (P<0.01, respectively) in cTnI、GOT and CK.Conclusion:After the preservation in the three kind of profound hypothermia cardioplegia solution for8hour, the heart function decrease. Cardioprotection effects of FW solution is better than the HTK solution in the isolated rat heart model during hypothermic preservation. Objective:To assess the effect of Fuwai organ preservation solution on endothelia relaxation and morphology in isolated rat thoracic aortic arteries.Methods:After rat thoracic aortic artery rings were incubated in FW (nicorandil0.1mmol/L), HTK, UW and Krebs solution at4℃for4hours, the structural change of endothelium was evaluated by light and electron microscopy, meanwhile pre-contraction induced by prostaglandin F2a (U4661930nmol/L) and endothelium-dependent relaxation induced by calcium ionophore(A2318710-10-10-6mol/L) were measured in the presence of indomethacin(7μmol/L) and LNNA(300μmol/L) in organ chamber.Results:Under light microscopy observation,there was no significant damage of endothelium among the FW group, the HTK group, the UW group and the control (KH) group. Under electron microscopy observation, the of endothelium damages of the group HTK and the FW group were lighter than the UW group. The maximal relaxation response induced by A23187in group FW (65.89%±10.42%) and in group HTK (63.92%±11.31%) was higher than that in group KH(42.57%±12.04%), whereas the maximal relaxation in group UW (32.06%±12.43%) was lower than that in group KH (P<0.05).Conclusion:Under deep hypothermia condition, the FW solution is superior to the UW solution in the endothelium preservation in the isolated rat thoracic aortic arteries. Methods:To study the effect of the FW solution on sodium channel (INa) in ischemia-reperfusion (I/R) neonatal rat myocytes.Methods:Myocytes were primary cultured for18-48h before using in the experiment. Cells were treated with I/R in the I/R group and with I/R plus Histidine-tryptophan-ketoglutarat (HTK) solution or FW solution in the HTK and the FW group, respectively. Whole cell patch clamp was used to record the current and gating.Results:The peak current density in the FW group decreased significantly than the I/R and the HTK group (-305.9±64.1pA/pF vs-617.2±74.2pA/pFand-547.3±20.8, P<0.05), the Ⅰ-Ⅴ curve of the FW group up-shifted. The peak current in the HTK group decreased than the I/R group, however no significant difference was observed. Compared with the I/R and the FW group, the activation and inactivation curves of the HTK group left-shifted.Conclusions:FW solution could inhibit the Ina current after I/R injury in neonatal rat myocytes without affecting the gating characteristics of the channel. This could help alleviating intracellular Na+and calcium (Ca2+) overload.