• Proceedings of the KTCVS Conference
• /
• 1993.06a
• /
• pp.120-120
• /
• 1993

• Journal of Chest Surgery
• /
• v.28 no.10
• /
• pp.885-891
• /
• 1995

In order to test the hypothesis that the pulmonic valve, when used to replace the aortic root as a pulmonary autograft, will remain a viable anatomical structure and will grow and develop normally along with the host, we performed aortic valve replacement with the pulmonary autograft in 15 neonatal piglets. The weight of the donor was 9.3 $\pm$ 0.2 kg, the recipient 9.6 $\pm$ 0.3 kg. Measured diameters of pulmonic annulus were 14 $\pm$ 0.2 mm for autograft and 14.2 $\pm$ 0.2 mm for pulmonary artery homograft. Operation was performed under cardiopulmonary bypass with deep hypothermia [20oC at low flow perfusion [70 ml/kg/min . The mean operation time was 227 $\pm$ 10 min., bypass time 152$\pm$ 7.6 min. and aortic cross clamp time 73$\pm$ 4.6 min.. 9 piglets survived more than 12 hours. One survived 12 days and died of pneumonia and the latest one survived in good condition and sacrificed at postoperative 6th week for cardiac catheterization and pathologic examination that revealed the viability and growing of the pulmonary autograft. Currently we are able to complete the operation with good preservation of cardiac function, and our postoperative care has evolved to the extent that we are now confident enough of having an acceptable percentage of long term survivors to undertake a definite study in this regard.

• Journal of Chest Surgery
• /
• v.26 no.6
• /
• pp.427-440
• /
• 1993

The paucity of donor hearts for transplantation can be remedied by distant heart procurement. Prolonging donor heart preservation is essential for successful clinical cardiac transplantation. Thirty-two isolated rat hearts were perfused with Krebs-Henseleit buffer solution for 15 minutes, arrested and preserved at 4 oC for 4 hours, and then reperfused for 25 minutes. The following three groups were prepared and hemodynamic changes, creatine kinase-MB isoenzyme levels and ultrastructural changes of the myocardium were analysed before and after cardiac arrest. ; Group I : the heart was arrested with the cardioplegic solution [Plegisol, potassium : 16 mM, sodium : 120 mM] and then stored in a solution with ionic compositions of the extracellular fluid [Hartman, potassium : 4 mM, sodium : 130 mM] ; Group II : the heart was arrested with the cardioplegic solution and stored in a solution with ionic compositions of the intracellular fluid [Modified Euro-Collins, potassium : 108 mM, sodium : 10 mM] ; Group III : the heart was arrested with the cardioplegic solution containing adenosine 20 uM, and then stored in a solution with ionic compositions of the intracellular fluid [Modified University of Wisconsin solution, potassium : 119 mM, sodium: 23 mM]. Left ventricular developed pressure at 20 minutes of the reperfusion was significantly higher in group III [64.3 $\pm$ 3.12 mmHg, p<0.01] and group II [58.3 $\pm$ 1.55 mmHg, p<0.05] as compared with group I [51.4$\pm$ 2.78 mmHg]. The time to induce cardiac arrest after infusion of cardioplegic solution with adenosine 20 uM [5.3 $\pm$ 0.30 second, p<0.005] was significantly shorter than without adenosine [10.6$\pm$ 0.55 second]. Coronary flow at 20 minutes of the reperfusion was augmented significantly in group III [9.6$\pm$ 0.50 ml/min, p<0.05, p<0.05] as compared with group I [8.0 $\pm$ 0.41 ml/min] and group II [8.1$\pm$ 0.51 ml/min]. Percentage recovery of left ventricular developed pressure at 20 minutes of the reperfusion was significantly higher in group III [94.6$\pm$ 2.51 %, p<0.005] as compared with group II and in group II [83.1 $\pm$ 1.22 %, p<0.005] as compared with group I [69.9 $\pm$ 1.73 %], and also percentage recovery of coronary flow at 20 minutes of the reperfusion was significantly higher in group III [82.3 $\pm$ 3.86 %, p<0.05] as compared with group II [71.4 $\pm$ 3.46 %] but there was no significant difference between group I and group II. Measured level of creatine kinase-MB isoenzyme at 15 minutes of the reperfusion was significantly lower in group III [1.23 $\pm$ 0.16 ng/ml, p<0.025] and group II [1.42$\pm$ 0.10 ng/ml, p<0.05] as compared with group I [1.79 0.14 ng/ml]. In the semiquantitative evaluation of the ultrastructural changes of the myocardium, mitochondrial score was lower in group III [0.7 $\pm$ 0.21] than in group I [3.1$\pm$ 0.28] and group II [1.7 $\pm$ 0.19], and also the other structural score was lower in group III [2.7$\pm$ 0.99] than in group I [7.9 $\pm$ 0.89] and group II [5.0 $\pm$ 1.22]. In conclusion, the solution with ionic compositions of the intracellular fluid is appropriate for prolonged cardiac preservation, and it appears to be better preserving method for distant procurement when the donor heart is rapidly arrested with cardioplegic solution containing adenosine 20 uM, and then stored with Modified University of Wisconsin solution.

• Journal of Chest Surgery
• /
• v.37 no.5
• /
• pp.391-400
• /
• 2004

Xenotransplantation in discordant species results in immediate and irreversible hyperacute rejection due to natural antibodies, IgM. With this, antibody depletion is one option to reduce hyperacute rejection, we investigated the effect of PCPP (postcentrifugal plasmapheresis) on the depletion of natural antibodies and the effect of antibody titer on xenograft survival. Material and Method: Outbred swines (n=4) weighing 10∼20 kg were used as donors and mongrel dogs (n=4) weighing 25∼30 kg were used as recipients. Recipient canines underwent plasmapheresis (COBE TPE Laboratories, Lakewood. CO, USA). Pre-transplantation PCPP was peformed on day －2 and day 0. There were three groups (Group 0: no PCPP, Group 1: 1 pla sma-volume (PV) at day －2 and 2 PV at day 0, Group 2: 2 PV at day －2 and 2 PV at day 0). A swine heart was heterotopically transplanted into a recipient's abdominal infrarenal aorta and inferior vena cava. Mean percent depletion of total IgM and IgG in plasma of the recipients was calculated. Serum albumin, electrolyte, complement activity and coagulation factors were measured. Histopathologic examination of heart specimens was performed. Result: Mean percent depletion of IgM and IgG were 95.7$\pm$1.2%, 80.5$\pm$2.4% in the group 2 at the end of PCPP. The percent depletion of serum albumin concentration was decreased from 2.8 to 1.4 g/㎗ in the group 1 and 3.0 to 1.5 g/㎗ in the group 2. Complement hemolytic activity was decreased in group 1 and 2, but returned to normal level within 24 hours. Complement hemolytic activity was reduced to 10% of pre-PCPP level in group 2. Serum fibrinogen decreased to 20% or less and was recovered within 24 hours in group 2. Antithrombin III decreased but less than fibrinogen. PT and aPTT were sometimes but not always prolonged during plasmapheresis. After plasmapheresis, PT and aPTT were prolonged beyond the measurable level. D-dimer was not found during PCPP, but appeared and maintained from 10 minutes after trasplantation. Graft Survival time was 5 min in group 0, and it was 90$\pm$0 min in the group 2. Histopathologic changes were more typically characterized by edema, hemorrhages, thrombosis in all groups at the end of experiment. Conclusion: PCPP effectively removed immuoglobulins and reduced the titer of natural antibodies, as a result, significantly prololonged swine heart xenograft survival.