Distant heart procurement: Impacts of storage solution composition on cardiac performance following transplantation

Abstract

In distant heart procurement, optimal storage conditions remain to be defined, especially with respect to the electrolytic concentrations of storage solutions. Between December 1986 and April 1987, heart transplants were carried out in 18 patients. After cardioplegic arrest (St. Thomas), the hearts were randomly stored in either Euro-Collins' solution (ECS; n = 9) or Ringer's solution (RS; n = 9) at 4 degrees C. For the first 24 h postsurgery, atrial pressures (LAP, RAP), systemic (MAP) and pulmonary pressures (PAP), and cardiac output (CO) were monitored. In addition, catecholamine and nitroglycerin requirements as well as the type of cardiac rhythm were documented. There was no significant difference between the groups in terms of the period of graft ischemia (ECS, 162 +/- 28 min; RS, 141 +/- 47 min); the MAP, RAP, LAP, and CO were also similar in both groups. The total amount of epinephrine needed to maintain the MAP between 60 and 80 mm Hg was 10.5 mg/24 h +/- 4.1 mg in ECS compared with 19.9 mg/24 h +/- 12 mg in RS (P less than 0.05). Despite less inotropic support, the left cardiac work index was considerably higher in the ECS group (P less than 0.05). In the first few postoperative hours, 8/9 RS patients needed either atrial (n = 4) or ventricular pacing (n = 4) for a heart rate of 90-100 beats/min (bpm), whereas only three ECS patients required atrial pacing (P less than 0.05). All other ECS hearts showed a spontaneous sinus rhythm.(ABSTRACT TRUNCATED AT 250 WORDS)