Effect of prolonged cardiac graft preservation on adhesion protein activation and synthetic endothelial function

Objective: to conduct a comparative study of the efficacy of Custodiol^® cardioplegia (Custodiol HTK, Dr. Franz Köhler Chemie GmbH, Bensheim, Germany) and normothermic autoperfusion of heart graft as a part of an ex vivo cardiopulmonary complex (CPC).

Methods. Landrace pigs weighing 50 ± 5 kg and aged 4–5 months (n = 10) were used as the model for a series of acute experiments. In the experimental group (n = 5), the CPC was conditioned by autoperfusion for 6 hours. In the control group, the heart’s pumping function was restored after a 6-hour cold preservation with Custodiol^®. The effectiveness of cardiac graft preservation methods was evaluated by measuring myocardial ischemic markers, endothelial synthetic function, and endothelial cell activation markers (E- and P-selectins, endothelial growth factor).

Results. Following cardiac graft reperfusion, the control group exhibited a statistically significant increase in the concentration of myocardial ischemia markers; also, there was a significant decrease in the synthesis of endothelium-derived relaxing factor in the Custodiol^® solution preservation group (378.5 [226.4; 539.7] vs. 542.1 [377.6; 853.2] μM/mL in the autoperfusion group, p < 0.05). The degree of coronary endothelial reperfusion injury/activation was several times higher in the control group than in the normothermic autoperfusion conditioning group. Moreover, cardiac output after a 6-hour graft conditioning was 0.63 [0.37; 0.80] and 0.37 [0.23; 0.37] L/min in the experimental and control groups, respectively (p < 0.05).

Conclusion. Normothermic autoperfusion showed a significant advantage in preserving the morphofunctional status of the donor heart compared with cold preservation with Custodiol^® during 6 hours of ex vivo graft conditioning.

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