依达拉奉联合供心复跳后不停跳保存技术提高缺氧诱导的无心跳猪供心移植效果

Effect of edaravone plus beating-heart-preservation technique on myocardial protection in donation after cardiac death heart transplantation

目的观察依达拉奉联合供心复跳后不停跳保存和移植技术提高缺氧诱导的无心跳猪供心的移植效果。方法杂种家猪36只，取12只用于供血，用随机数字表法将其余24只分为实验组和对照组，每组供、受者各6对。（1）实验组：供心经缺氧诱导停跳后，继续热缺血25min，阻断主动脉，用含依达拉奉氧合冷血经主动脉根部灌注。供心被切取后在离体灌注装置上进行氧合温血持续灌注复苏，并于复灌初期5min时再次使用依达拉奉，心脏在体外持续跳动保存2h。（2）对照组：全程不用依达拉奉，其他操作与实验组完全相同。两组供心保存结束后，进行心脏移植，移植过程中保持供心持续跳动。在停呼吸机前（供心缺氧前）、主动脉开放后60和120min等时点检测供心血流动力学指标，心肌酶，心肌组织含水量，以及对心肌组织进行电镜观察。结果两组供者均成功脱离体外循环机。（1）供心缺氧前，两组间血流动力学指标的差异无统计学意义；主动脉开放后60和120min时，实验组显著优于对照组（P〈0．05）。（2）主动脉开放后120min时，两组间各心肌酶水平均较供心缺氧前明显上升，但两组间差异无统计学意义（P〉0．05）。（3）对照组心肌组织含水量显著高于实验组（P〈0．05）。（4）经电镜观察，对照组心肌细胞z带欠清晰，线粒体轻度肿胀，部分嵴溶解，内质网肿胀，糖原颗粒减少；实验组心肌细胞线粒体嵴无断裂，内质网清晰可见，未见明显破坏。结论将热缺血时限控制在25min内，缺氧诱导的无心跳供者供心可用于移植；供心经离体氧合温血持续灌注，在不停跳下进行保存和移植的方法可行，心肌保护效果满意；依达拉奉可进一步提高缺氧诱导的无心跳供者供心的保护效果。

Objective To investigate the effect of edaravone plus beating-heart-preservation as well as beating-heart-transplantation technique on myocardial protection in donation after cardiac death （DCD） heart transplantation. Methods Twenty-four swine （body weight 28 ± 3 kg） were divided into two groups （n = 12 each）, and another twelve swine were used for blood donor. （1） Experimental group： cardiac arrest was induced by asphyxiation （turning off the ventilation）, and then the swine were subjected to 25-min warm ischemia, and cold oxygenated blood was perfused before the harvest of donor heart. Cardiac resuscitation was initiated by the ex vivo perfusion equipment and warm oxygenated blood was reperfused. Edaravone was given before harvesting of donor heart and in the early period of reperfusion. Donor hearts were kept beating throughout preservation and transplantation period. （2） Control group., all animals were treated in the same way except for without the application of edaravone. Hemodynamic, myocardial enzymes, and water content of myocardium were observed, and ultrastructural damage of eardiomyocytes was examined. Results All recipient animals could wean from cardiopulmonary bypass successfully. Left ventrieular compliance and left ventricular contractility were significantly better preserved in experiment group than in control group. Though there was no significant difference in myocardial creatase level, the myocardial edema in experimental group was milder than in control group, and myocardial ultrastructure was better preserved in experimental group. Conclusion Heart from DCD, even though experienced 25-min warm ischemia after cardiac arrest by asphyxiation, still could be resuscitated via isolated heart perfusion equipment （ i. e. , heating-heart-preservation ） successfully. Furthermore, transplantation is feasible technically. Edaravone, a free-radical scavenger, beating-heartcould alleviate asphyxiation-induced myocardial injury, and further improve post-transplantation heart function.