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Ann Thorac Surg 1997;63:1664-1668
© 1997 The Society of Thoracic Surgeons

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Original Article: Cardiovascular

Intravenous Phenylephrine Preconditioning of Cardiac Grafts From Non–Heart-Beating Donors

Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health Sciences Center, Charlottesville, Virginia

Accepted for publication December 14, 1996.

Background. Hypoxia and warm ischemia produce severe injury to cardiac grafts harvested from non–heart-beating donors. To potentially improve recovery of such grafts, we studied the effects of intravenous phenylephrine preconditioning.

Methods. Thirty-seven blood-perfused rabbit hearts were studied. Three groups of non–heart-beating donors underwent intravenous treatment with phenylephrine at 12.5 (n 8), 25 (n 7), or 50 µg/kg (n 7) before initiation of apnea. Non–heart-beating controls (n 8) received saline vehicle. Hypoxic cardiac arrest occurred after 6 to 12 minutes of apnea, followed by 20 minutes of warm in vivo ischemia. A 45-minute period of ex vivo reperfusion ensued. Nonischemic controls (n 7) were perfused without antecedent hypoxia or ischemia.

Results. Phenylephrine 25 µg/kg significantly delayed the onset of hypoxic cardiac arrest compared with saline controls (9.6 0.5 versus 7.7 0.4 minutes; p 0.00001), yet improved recovery of left ventricular developed pressure compared with saline controls (57.1 5.3 versus 41.0 3.4 mm Hg; p 0.04). Phenylephrine 25 µg/kg also yielded a trend toward less myocardial edema than saline vehicle (p 0.09).

Conclusions. Functional recovery of nonbeating cardiac grafts is improved by preconditioning. We provide evidence that the myocardium can be preconditioned with phenylephrine against hypoxic cardiac arrest.

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