The effects of brain death and 24 hours' storage by hypothermic perfusion on donor heart function in the pig

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 91; no. 6; pp. 896 - 909
• Main Authors: Wicomb, WN, Cooper, DK, Lanza, RP, Novitzky, D, Isaacs, S
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA AATS/WTSA 01.06.1986; Elsevier
• Subjects: Adenosine Triphosphate - metabolism; Animals; Biological and medical sciences; Brain Death; Cardiac Output; Coronary Circulation; Creatine Kinase - metabolism; Glycogen - metabolism; Heart - physiology; Heart Arrest, Induced - methods; Heart Rate; Heart Transplantation; Hypotension - physiopathology; Lactates - metabolism; Medical sciences; Myocardium - metabolism; Organ Preservation; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Swine; Time Factors; Vascular Resistance; Heart; Cardiovascular disease; Brain (Vertebrata); Induced hypothermia; Shelf life; Homotransplantation; Pig; Vertebrata; Mammalia; Death; Artiodactyla; Experimental surgery; Ungulata
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/s0022-5223(19)35969-0

The effects on the myocardium of the agonal period and subsequent management have been studied in the pig. Acute ischemia of the brain led to major temporary hemodynamic changes. Brain death, with or without hemodynamic support of the circulation, led to a significant reduction in subsequent myocardial function, associated with some depletion of the myocardial high-energy phosphate and glycogen reserves, although the rate of this depletion was reduced by anaerobic glycolysis. Although 24 hours' storage by continuous hypothermic perfusion of hearts taken from control animals led to only a minimal reduction in myocardial function, storage increased the reduction in function associated with brain death when intravenous fluid and dobutamine support had been given to maintain the brain dead pig in a normotensive state. Storage, however, reduced the anaerobic metabolism seen in hearts functioning in hypotensive brain dead pigs and led to replenishment of the glycogen stores.