Ann Thorac Surg 2001;71:1295
© 2001 The Society of Thoracic Surgeons
Invited commentary
William L. Holman, MDa
a Department of Cardiothoracic Surgery, University of Alabama at Birmingham, 1530 3rd Ave S-ZRB 719, Birmingham, AL 35294-0007, USA
e-mail: wholman{at}its.uab.edu
This article by Redondo and associates describes the effect of hypothermia on cultured porcine coronary endothelial cells maintained in either a balanced salt solution (control medium) or University of Wisconsin (UW) solution. This makes the study a complex one because there are two interventions (hypothermia and solution type) to evaluate. Nevertheless, the authors were able to show superior endothelial cell viability in the UW group that was associated with lower Na/K/Cl cotransport activity and less cell swelling as compared to the hypothermic control medium group. The authors did not directly measure intracellular ion content, but by inference sodium played a pivotal role in the endothelial cell injury that was observed. The importance of sodium influx to cell swelling and other ionic derangements (eg calcium influx) that result in cell death from ischemia-reperfusion injury is currently an active area of investigation. New drugs that improve ionic homeostasis in the face of ischemia-reperfusion injury, and that may prove useful in protecting donor hearts, are partially responsible for stimulating this interest.
As the authors indicate in their final paragraph, identifying and correcting the gaps in donor heart protection afforded by UW and similar intracellular-type solutions is a rational direction to pursue with the goal of improved results for cardiac transplantation. Exactly how improved endothelial cell viability in donor hearts will affect short- and long-term results of cardiac transplantation is not currently known, but it is possible that preventing endothelial injury will lead to improved early graft function by preserving normal coronary vasomotor tone and microvascular permeability. Improved endothelial cell survival may also retard the development of allograft vasculopathy, which is a major determinant of long-term donor heart survival. The information presented in this article increases our understanding of endothelial injury associated with current procurement methods and is, therefore, an important step towards improving results in cardiac transplantation.
Related Article
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Cell volume and ionic transport systems after cold preservation of coronary endothelial cells
- Juliana Redondo, María E. Pacheco, Ana M. Manso, Mercedes Salaices, and Jesús Marín
Ann. Thorac. Surg. 2001 71: 1290-1295.
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