| Background:Heart transplantation (HTX) remains the first choice for surgical treatment of terminal stage heart failure. The survival of heart transplantation were satisfactory all over the world, but HTX has been limited by organ availability. If we can use non-heart-beating donor (NHBD), the donor pool might be be enlarged. Asphyxia induced NHBD heart, among other class of NHBD heart, was more potentially fessible for clinic HTX, unforturnatly, compared with heart arrest by exsanguination, myocardil injury in the former was formidable, and the protection for it has been therefore much more tough and chanlenge,require optimized myocardial protection.Objective:This study is to establish whether the asphyxia induced NHBD heart be really useable and second whether an integrated strateges (edaravone, plus beating heart preservation, and beating- heart transplantion technique) could enhance the efficace of resuscitation , what is the safe time of warm-ischemia time ,and finally whether the beating heart preservation and beating- heart transplantion could be used without much difficulty technique.Material and method:36 domestic male porcine( weighting 28±3Kg) were randomly chosen to receive either experimental group(E) and control group (c) .(n=18 in each group: 6 for donor/receptor, respectively, 6 for blood donor).①E group: donor heart was induced arrested by hypoxia (withdraw of ventilation), followed by 25min warm ischemia (keeping in room temperature) subsequently,edaravone (3mg/kg)enriched oxygenated warm blood cardioplegia(20ml/kg) was perfused through the root of aorta, and the heart was excised and hanging on the langendorff perfusion apparatus.Continuous myocardial reperfusion was immediately commenced from the aortic root with the edaravone (3mg/kg)enriched oxygenated warm blood during the early period of reperfusion, with the oxygenated warm blood for the rest of reperfusion .All the reperfusion time last for 2 hours, while the heart was resuscitated and keep beating.②C group: all was the same except for without application of edaravone.After preservation, hearts were transplanted with bicaval technique, while donor hearts still keep beating.Hemodynamic parameters were recorded and myocardial enzymes evaluated before hypoxia (baseline), at 60 min /120min after decrossclamping of aorta.myocardium tissues were obtained for myocardial water content determination, for light microscope and scanning electron microscope observation.Result:All the animals in the two groups could wean successfully from cardiopulmonary bypass. Left ventricular compliance and left ventricular contractility were significantly better preserved in E group than C group. Myocardial enzyme was elevated significantly in both groups, but still lower in E group than in C group. Also, the percentage of myocardial water content was significantly lower in E heart compared with C heart. While no difference was found between two groups regarding myocardial microstructure, myocardial ultrastructure was better preserved in E group as compared with C group.Conclusions:Aypoxia induced NHBD heart,though experienced 25min warm ischemia after heart arrest, was still suitable for HTX. Beating-heart preservation and beating heart transplantation was feasible from the view of technique. Heart resuscitation via integrated stratege (i.e., edaravone plus beating heart preservation and beating heart transplantation as described above), could improve the efficacy of myocardial protection of NHBD donor. |
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