Assessment of left ventricular compliance during heart preservation

Abstract

There is critical need for a greater number of donor hearts for transplantation. The demand can be relieved, in part, by an extension of preservation time. This necessitates new methods of preservation and development of means to assess the functional condition of the preserved heart. We report a heart-preservation system designed for long-term preservation support and discuss issues specifically related to extended heart preservation. This article presents methodology to assess ventricular compliance and to quantify coronary flow distribution during the use of microperfusion preservation. Ventricular adenosine triphosphate (ATP) concentrations are directly related to the immediate post-preservation function: however, direct measurement of ATP is not clinically available. Based on the premise that ventricular compliance relates directly to the ventricular ATP concentrations, we performed sequential ventricular compliance measurements using a simple left ventricular balloon during a 24 h preservation period. A porcine heart model was employed using a continuous, hypothermic, antegrade, microperfusion system for 24 h and measurements were made at specific intervals during the preservation time. The compliance measurements were ascertained by pressure-volume curves using a flaccid balloon inserted into the left ventricle through the mitral valve. In addition, to assess microvascular function during the preservation interval, regional coronary flow measurements were performed using a microsphere technique. We report that after 12 h of preservation there was a twofold reduction in ventricular compliance which decreased further by fivefold at 18 h. In contrast, there was a time-dependent decrease in left ventricular coronary flow, especially with the left-ventricular subendocardial region significantly decreasing by 50% at 12 h. In conclusion, a simple ventricular-compliance balloon provided a direct measurement of ventricular compliance of the preserved heart which may provide an indirect estimate of the ventricular high-energy phosphates of the preserved heart prior to transplantation.

Get full access to this article

View all access options for this article.

References

Kevelaitis E , Mouas C , Menasche P.

Poststorage diastolic abnormalities of heart transplants: is vascular dysfunction or myocardial contracture the culprit?

J Heart Lung Transplant 1996; 15: 461-469 .

Schilling M , Saunder A , Southard JH , Belzer FO. Five-to-seven day kidney preservation with aspirin and furegrelate . Transplantation 1993; 55: 955-958 .

Southard JH , Belzer FO. Organ preservation . Ann Rev Med 1995; 46: 235-247 .

Manciet LH , Larson DF , Copeland JG. Low-pressure perfusion results in effective microvascular perfusion of isolated rabbit hearts during hypothermic preservation for 24 hours . J Heart Lung Transplant 1991; 10: 710-716 .

Copeland JG , Jones M , Spragg R , Stinson EB. In vitro preservation of canine hearts for 24 to 28 hours followed by successful orthotopic transplantation . Ann Surg 1973; 178: 687-692 .

Wang SY , Stamler A , Tofkuji M , Deuson TE , Sellke FW. Effects of blood and crystalloid cardioplegia on adrenergic and myogenic vascular mechanisms . Ann Thorac Surg 1997; 63: 41-49 .

Murphy CO , Pan-Chih, Gott JP , Guyton RA. Coronary microvascular reactivity after ischemic cold storage and reperfusion . Ann Thorac Surg 1997; 63: 20-27 .

Sellke FW , Shafique T , Schoen FJ , Weintraub RM. Impaired endothelium-dependent coronary microvascular relaxation following cold potassium cardioplegia and reperfusion . J Thorac Cardiovasc Surg 1993; 105: 52-58 .

Evora PRB , Pearson PH , Schaff HV. Crystalloid cardioplegia and hypothermia do not impair endothelium-dependent relaxation or damage vascular smooth muscle of epicardial coronary arteries . J Thorac Cardiovasc Surg 1992; 104: 1365-1374 .

10.

McDonagh PF , Laks H. Use of cold blood cardioplegia to protect against coronary microcirculation injury due to ischemia and reperfusion . J Thorac Cardiovasc Surg 1982; 84: 609-618 .

11.

Wang SY , Friedman M , Franklin A , Sellke FW. Myogenic reactivity of coronary resistance arteries after cardiopulmonary bypass and hyperkalemic cardioplegia . Circulation 1995; 92: 1590-1596 .

12.

Stringham JC , Southard JIT , Hegge J , Triemstra L , Fields BL , Belzer FO. Limitations of heart preservation by cold storage . Transplantation 1992; 53: 287-294 .

13.

Gatewood LB , Larson DF , Bowers MC , et al. A novel mechanism for cyclosporine: Inhibition of myocardial ischemia and reperfusion injury in a heterotopic rabbit heart transplant model . J Heart Lung Transplant 1996; 15: 936-947 .

14.

Mankin PS , Severs NJ , Lachno DR , Rothery S , Yacoub MH. Superior qualities of University of Wisconsin solution for ex vivo preservation of the pig heart . J Thorac Cardiovasc Surg 1992; 104: 229-240 .

15.

Calhoon JH , Bunegin L , Gelineau JF et al. Twelve-hour canine heart preservation with a simple, portable hypothermic organ perfusion device . Ann Thorac Surg 1996; 62: 91-93 .

16.

Burt JM , Larson DF , Copeland JG. Recovery of heart function following 24 hours preservation and ectopic transplantation . J Heart Transplant 1986; 5: 298-303 .

17.

Larson DF , Stringer SK , Goldberg MC , Kern KB , Manciet LH , Copeland JG. Mechanisms of neutrophil mediated myocardial dysfunction . Proc Am Acad Cardiovasc Perf 1993; 14: 28-33 .