| 1 BackgroundHeart transplantation is the most effective method for treating the end-stage heart disease, because the heart transplant strict selection criteria for the heart to heart for serious shortage of donor heart caused by the strict clinical criteria for heart transplantation, a large number of patients, while waiting for a heart transplant, died, or those who had had heart transplant couldn’t make a long-term survival for donor heart being hit during the preservation and transplantation., It is also hard for heterotransplantation to apply the clinic because of immune rejection, and artificial heart is just regard as an interim basis for existing problems. At present, as the number of people needed to have heart transplant increasing, the time of waiting for heart transplantation is extending. This increases the mortality of patients in the period of waiting for heart transplantation. The traditional criteria for heart transplant, the appropriate donor heart should come from the brain death and heart beating donor, is formulated by Copeland, etc. In order to change the actuality of demand exceeds supply of the donor heart, it needs to improve the preservation method to increase the success rate of heart transplantation and prolong the survival time and the quality of life of patient. Margin donor, in recent years, has been research focus. Abstract Marginal donor organs, such as the donor organ without heart beating, the organs maintained with a great dose of drugs, the donor organs with a long time of cold ischemia, the organs coming from old peoples, etc. These donors, have some diseases in themselves. However, after transplantation, these diseases can be cured during the receptor rehabilitation. These, to some extent, for extending the number of the donor provide a effective way to solve the shortage of donor heart. Non-heart-beating donor (NHBD) has a good application prospect and can contribute to alleviate the shortage situation of donor heart.Long time ischemia is the most important problem that the marginal donor heart faced. How to preserve the donor for a long time and improve the survival rate of heart transplantation are the challengeable for the heart save technology. The common method of save organs includes the following two aspects:1, the pure cooling method, application of metabolism inhibitors to reduce metabolism, without supplying for oxygen and energy. Low temperature can effectively reduce energy consumption of the myocardial metabolism. Practices have proved that the metabolic rate at 4℃can decreased to the 1/10 of that at normal temperature. At this time, the energy consumption of myocardium is the lowest. Unfortunately, as the heart restart time being delayed, the endothelial cells are reduced to being injured. This increased incidence of late graft vascular lesions.2, continuous machine perfusion method, including the normal temperature machine perfusion and low temperature machine perfusion, can keep the donor organs have the same sate as in the body metabolism. The cardioplegia, that can lead to cardiac arrest and supply more energy substrate to the heart that can reduce myocardial injury during preservation and the reperfusion injury, has been widely used by clinic. Unfortunately, it can not be used to preserve heart for a long time. The blood cardioplegia, for being much more similar with the physiological state and having excellent protection to the myocardial warm ischemia injury, has been used by clinic successfully.Continuous perfusion through coronary artery can provide physiological eternal environment closed to the physiology to donor heart that can maintain the aerobic metabolism of myocardial tissue and alleviate acidosis and supply abundant of energy rich phosphate compounds. It has showed a great myocardial protection. This research has the study on the effects of the different preservation conditions after 4 hours of the swine donor heart with the hot ischemia for 10 minutes to allograft heart transplantation and the impact and clinical value of the micro-flow perfusion with blood cardioplegia in the preservation of donor heart.2 Materials and Methods2.128 healthy Swedish domestic pigs were randomly divided into two groups, Experimental and control groups.Every group were 14 pigs, then choose seven groups as a donor, seven as a receptor. All pig given intramuscular anesthetics after induction of anesthesia, and then the ear vein given Pancuronium bromide, combined with ketamine hydrochloride anesthesia. Tracheal intubation after Tracheotomy and use mechanical ventilation. Internal jugular vein and external jugular vein puncture for observed central venous pressure and arterial pressure connected to ECG monitoring, When every indicators were stabilization,we will do operation and exposed the heart. Collected to non-leukocyte with blood and platelet with blood cross to internal jugular vein puncture, and harvested the donor heart after heart warm ischemia of 10 minutes.2.2 The experimental group and control group donor hearts were placed in Plegisol with blood in low temperature micro-flow continuous perfusion system continuous perfusion for 4 hours,4℃Plegisol solution soak for 4 hours after heart transplantation. Shumway orthotopic heart transplantation classic surgicalfor heart transplant receptors in the control group underwent heart transplant during the period to maintain a low temperature (4℃) in the pleural cavity, the experimental group shift with blood in Plegisol low temperature micro-flow continuous perfusion.2.3 Recorded after 7 days, hemodynamic parameters, such as heart rate (HR), mean arterial pressure (MAP), heart transplant heart resuscitation, and the ultrasound probe record cardiac output (CO), average coronary blood flow (CF); acquisition after 0 hour,6th hour,12th hour,1st day,3rd day,7th day, venous determination of cardiac troponin T (cTnT), myoglobin (Mb) levels. Executed the experimental pigs after removal of the donor heart for the determination of myocardial water content (MWC).2.4 All data were processed with statistical software SPSS 17.0 all the data are x±S, two sets of quantitative data were analyzed using t test, t-test are not met by t ’test. The inspection level a=0.05, P value less than 0.05 was considered statistically significant.3 Results3.1 The resuscitation of hearts:experimental group had 3 pigs occurred ventricular fibrillation after heart transplantation, and to give defibrillation to restore sinus rhythm,4 pigs restore to sinus rhythm automatically. The control group had 5 pigs occurred ventricular fibrillation after heart transplantation,4 pigs ventricular fibrillation restore to sinus rhythm after defibrillation, while 1 pig died because of sustained ventricular fibrillation,2 pigs restore to sinus rhythm automatically.3.2 Average heart rate, mean arterial pressure, cardiac output, myocardial water content results in coronary blood flow in 7 days:the experimental group heart rate: 105.3±9.8 times per minute, mean arterial pressure:76.36±7.27 mmHg heart output: 2.62±0.04 L/min, coronary blood flow:88.59±6.32 L/min, myocardial water content: 78.55±0.48%; heart rate of the control group:109±10.0 beats per minute, mean arterial pressure:53.08±7.13 mmHg, cardiac output:1.80±0.10 L/min, coronary blood flow:76.18±5.14 L/min, myocardial water content:79.77±0.53%. Average heart rate and myocardial water content of the experimental and control groups was not statistically significant (P>0.05), the experimental group, mean arterial pressure, cardiac output, coronary blood flow was significantly higher than the control group, and statistical significance (P<0.05).3.3 The protein of myocardial:two groups of cTnT, Mb levels after heart transplantation, after declining in the control group of cTnT, Mb of the levels were significantly higher than the experimental group, the difference was statistically significant (P<0.05), suggesting that the of the extent of the damage myocardium was significantly higher than the experimental group.4 ConclusionOur results indicate that the myocardial protective effect of oxygenated Lecukocyte-depleted blood cardioplegia low flow perfusion is better than simple cold static storage.lt can significantly reduce wann ischemia for heart hemodynamic effects, attenuate myocardial ischemia-reperfusion injury, and confer a direct good protective effect on warm ischemic cardiac function and myocardial tissue of the donor heart in the heart transplantation. |
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