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Ann Thorac Surg 1990;50:80-85
© 1990 The Society of Thoracic Surgeons

Articles

Improved myocardial preservation during cold storage using substrate enhancement

Constance K. Haan, MD, Harold L. Lazar, MD*, Samuel Rivers, BS, Cheryl Coady, BS, Richard J. Shemin, MD

Department of Cardiothoracic Surgery, Boston University Medical Center, Boston, Massachusetts USA

Accepted for publication January 31, 1990.

* Address reprint requests to Dr Lazar, Department of Cardiothoracic Surgery, The University Hospital, 88 East Newton St, Suite B404, Boston, MA 02118.

This study was undertaken to determine whether substrate enhancement with L-glutamate during periods of cold storage would improve ventricular function in transplanted hearts. Thirty-one rabbit hearts were rapidly excised and perfused with Krebs-Henseleit buffer (37 °C) on a Langendorff apparatus. They were arrested with hypothermie (4 °C), crystalloid, potassium (25 mEq/L) cardioplegia and stored at 3 °C for three hours, followed by reperfusion with Krebs-Henseleit buffer for one hour. Hearts were treated in one of several ways: Group 1 (n = 8) did not receive any L-glutamate and served as controls; group 2 (n = 8) had L-glutamate (4 mmol/l) added to both the cardioplegic and reperfusate solutions; group 3 (n = 5) received L-glutamate only before ischemia; group 4 (n = 5) received L-glutamate only in the cardioplegic solution; and group 5 (n = 5) received L-glutamate only in the reperfusate. Hearts receiving L-glutamate in the reperfusate with or without its addition to the cardioplegic solution (groups 2 and 5) had the best recovery of the first derivative of positive and negative change in left ventricular peak systolic pressure and no significant changes in left ventricular compliance. Pretreatment with L-glutamate alone (group 3) resulted in no better recovery than in group 1 hearts. We conclude that addition of L-glutamate to reperfusate solutions after periods of cold storage for transplantation enhances the recovery of ventricular function.




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