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Ann Thorac Surg 1998;66:1953-1957
© 1998 The Society of Thoracic Surgeons

Original Articles

Preconditioning prevents myocardial stunning after cardiac transplantation

Roderick W. Landymore, MDa, Alexander J. Bayes, MDa, J. Thomas Murphy, MDa, John H. Fris, RTa

a King Fahad National Guard Hospital, Riyadh, Saudi Arabia

Accepted for publication May 28, 1998.

Address reprint requests to Dr Landymore, Department of Cardiac Sciences, King Fahad Hospital, P.O. Box 22490, Riyadh, Saudi Arabia

Presented at the Canadian Cardiovascular Society, Montreal, Quebec, Canada, October 29–November 2, 1996.

Background. Preconditioning has been shown to reduce myocardial stunning after reversible global ischemia. To determine whether preconditioning improves functional recovery after cardiac transplantation, 16 sheep were randomly assigned to a preconditioning protocol or to a control group.

Methods. Preconditioning was achieved with 5 minutes of global ischemia followed by 10 minutes of reperfusion. The heart was then arrested with 1 L of crystalloid cardioplegia, explanted, stored in a transport cooler, and then transplanted into recipient sheep. The total ischemia time was 2 hours. Pressure-volume loops were used to calculate preload recruitable stroke work, the maximum elastance, and diastolic compliance. Linear regression analysis was used to determine the preload recruitable stroke work, maximum elastance, and diastolic compliance–and end-diastolic volume relationship. The area under the regression curve for preload recruitable stroke work was defined as the preload recruitable stroke work area. Biopsies were taken for high-energy phosphates.

Results. Systolic function, represented by preload recruitable stroke work area, was preserved after cardiac transplantation in preconditioned animals. Maximum elastance and diastolic compliance were unaffected by preconditioning or ischemia. High-energy phosphates were better preserved in preconditioned animals.

Conclusion. Preconditioning prevented myocardial stunning and preserved high-energy phosphates after experimental cardiac transplantation.




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