A comparative study of the most widely used solutions for cardiac graft preservation during hypothermia

Abstract

Background Reports conflict on the benefits of preservative solutions. We investigated the efficacy of the most widely used cardioplegic solutions by comparing extracellular solutions such as Celsior solution, St. Thomas Hospital solutions 1 and 2 (STH-1, STH-2), the modified University of Wisconsin solution (UW-1), Lyon Preservation solution (LYPS) from our laboratory, and intracellular solutions such as standard University of Wisconsin solution (UW), Bretschneider solution (HTK), Stanford solution (STF), and Euro-Collins solution (EC). Methods Male rats ( n = 110) were randomized into 11 groups: LYPS, Celsior, STH-1, STH-2, UW-1, UW, HTK, STF, EC, and normal saline solution groups, and a control group. All hearts, except controls, were preserved by cold storage (8 hours at 4°C) in the various solutions. We used an isolated non-working-heart model and biopsy specimens to assess heart preservation ( n = 5/group). Results Hearts stored in the EC and saline solutions had poor left ventricular developed pressure (LVDP) × heart rate (HR) (1,407.5 ± 154 and 1,390 ± 439 mm Hg/mn, respectively). In contrast, hearts stored in LYPS and Celsior had a LVDP × HR close to control hearts (31,349 ± 1,847, 27,620 ± 1,207, and 36,627 ± 1,322 mm Hg/mn, respectively), whereas hearts stored in STH-1, STH-2, UW-1, UW, HTK, and STF had intermediate functional response (14,278 ± 2,176, 12,402 ± 1,571, 11,428 ± 1,629, 11,603 ± 2,521, 7,045 ± 537, and 7,086 ± 1,206 mm Hg/mn, respectively). Hearts preserved with STH-2, UW, HTK, STF, EC, and saline solution showed significantly increased release of creatine kinase and lactate dehydrogenase than did control hearts or hearts preserved in Celsior, LYPS, STH-1, and UW-1. The energetic charge (EC = [(0.5 adenosine diphosphate + adenosine triphosphate) ÷ (adenosine triphosphate + adenosine diphosphate + adenosine monophosphate)]) in STH-2, UW, HTK, STF, EC, and saline groups was significantly lower ( p < 0.05) than in the other groups. Conclusion Extracellular-type solutions provided better preservation than did intracellular-type solutions. However, UW and UW-1 (intracellular- and extracellular-type solutions) provided equivalent preservation of cardiac function. Preservation quality may be attributed to calcium, often added to extracellular solutions. Among extracellular solutions, Celsior and LYPS solution showed comparable efficacy on left ventricular function and seemed to offer better preservation than the other solutions tested in this study.