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Stephen M. Martin
Hillel Laks
Davis C. Drinkwater
Darryl G. Stein
Eli R. Capouya
Jeffrey M. Pearl
Paul Chang
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Ann Thorac Surg 1993;55:954-960
© 1993 The Society of Thoracic Surgeons

Articles

Perfluorochemical reperfusion yields improved myocardial recovery after global ischemia

Stephen M. Martin, MD, Hillel Laks, MD*, Davis C. Drinkwater, MD, Darryl G. Stein, MD, Eli R. Capouya, MD, Jeffrey M. Pearl, MD, Steven W. Barthel, BS, Paul Chang, BS, Elias Kaczer, Sunita Bhuta, Md

Divisions of Cardiothoracic Surgery and Pathology, University of California at Los Angeles Medical Center, Los Angeles, California USA

Accepted for publication July 29, 1992.

* Address reprints requests to Dr Laks, Division of Cardiothoracic Surgery, UCLA Medical Center 62-182A. 10833 Le Conte Ave, Los Angeles, CA 90024.

Reperfusion injury remains a limiting factor in extending ischemic storage time for human heart transplantation. In this study, initial myocardial reperfusion with an oxygenated perfluorochemical (Fluosol) was investigated as a means of limiting such injury. Neonatal piglet hearts were arrested with crystalloid cardioplegia, excised, and stored for 12 hours in saline solution at 0 °C. Initial reperfusion (10 minutes) was either with whole blood (n = 6), unmodified perfluorochemical (n = 8), or aspartate/ glulamate-enriched perfluorochemical cardioplegia (n = 6), and was followed by an additional 40 minutes of whole blood perfusion. Functional evaluation was then completed, and left ventricular biopsy specimens were taken. A control group (n = 7) was evaluated without an intervening period of ischemia. At a left ventricular end-diastolic pressure of 9 mm Hg, hearts stored in whole blood cardioplegia developed a left-ventricular strok? work index of 3.8 ± 2.3 x 103 erg/g (mean ± standard error of the mean). Under the same conditions, perfluorochemical-reperfused hearts achieved a stroke work index of 14.6 ± 1.3 x 103 erg/g, significantly greater than that of the whole blood group (p < 0.001). Stroke work index for hearts reperfused with aspartate/glutamate-enriched perfluorochemical cardioplegia was 19.8 ± 1.6 x 103 erg/g, significantly increased over that of the nonenriched perfluorochemical group (p < 0.01) and not different from values obtained in controls (19.2 ± 0.8 x 103 erg/g). In addition, perfluorochemical-reperfused hearts demonstrated superior maintenance (p < 0.05) of adenosine triphosphate (2.08 ± 0.16 µmol/g) compared with the whole blood group (1.50 ± 0.19 µmol/g), whereas preservation of adenosine triphosphate in the enriched perfluorochemical group (2.99 ± 0.12 µmol/g) was significantly increased over that of the nonenriched perfluorochemical group (p < 0.001 µmol/g) and not significantly different from that in controls (2.68 ± 0.17 µmol/g). Electron microscopy revealed notably improved preservation of ultrastructural architecture in perfluorochemical-treated hearts (with or without aspartate/ glutamate) compared with the whole blood group. We conclude that initial reperfusion of the postischemic myocardium with oxygenated perfluorochemical ameliorates the deleterious effects of whole blood reperfusion. In addition, amino acid enrichment, buffer supplementation, and chemical cardioplegia enhance this effect, allowing for complete functional recovery of the piglet myocardium after 12 hours of hypothermic ischemia.




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