Effects of cardioplegic flushing, storage, and reperfusion on coronary circulation in the pig

Intact endothelial and contractile function of coronary artery after 8 hours of heart preservation

“…Disturbance of the functional integrity of the vascular endothelium, known as "endothelium dysfunction", plays a significant role in myocardial ischemia-reperfusion injury (3)(4)(5)(6)(10)(11)(12). The vascular endothelium is a single layer of cells that lines the entire circulatory system.…”

“…In a study on porcine hearts, flushing the heart with 1 L of 4°C St. Thomas Cardioplegic Solution, using a perfusion pressure of 60 to 65 mmHg, significantly reduced endothelium-dependent relaxation (EDR); flushing followed by 12 hours of cold storage at 4°C significantly impaired EDR which worsened still more after 24 hours of reperfusion (3). A correlation was found (p<0.001) between high coronary vascular resistance and low EDR (3) and the coronary flow and cardiac output were significantly reduced in hearts with low EDR (4).…”

Preservation of the Endothelium in Cardiovascular Surgery – Some Practical Suggestions – A review

“…St. Thomas' solution, designed to depolarize the cardiac myocyte, does not preserve the vascular endothelium as well as UW or Perfadex (11,44,55,56) and should not be used for vascular graft preservation. UW has a very high concentration of potassium (140 mmol/l), it is a so-called "intracellular" solution (or high-potassium solution) in contrast to Perfadex, which is a low-potassium dextran solution (LPD solution).…”

“…In a model on adult pig hearts transplanted ex vivo, we have compared 2 and 12 h cardioplegic preservation of donor hearts (55,56). The cold ush perfusion per se injures the endothelium, as does the 12 h storage period.…”

“…The cold ush perfusion per se injures the endothelium, as does the 12 h storage period. The reperfusion creates further injury in the hearts preserved for 12 h. There is a strong correlation between endothelium-dependent relaxation and coronary vascular resistance (CVR), the more impaired the endothelium-dependent relaxation, the higher the CVR, and the more impaired the coronary ow after the rst reperfusion period with reactive hyperemia (56). Allograft coronary artery disease is the most common cause of death in the late post-transplantation period, limiting long-term survival after heart transplantation.…”