Objective To summarize the experiences of donor heart procurement of heart transplantation so as to improve the efficiency of donor heart protection. [WTHZ]Methods [WTBZ]From April 2002 to October 2006, sixtyone patients with endstage heart disease had undergone orthotopic heart transplantation. Donors were all male brain deaths, aged from 21 to 53, and 5 of them were older than 40. There were 6 cases in which the weight difference between donor and recipient＞20%, and the rest ≤±20%. Fortyfive cases had the same ABO blood type, and 16 had matching ABO blood type. Four donor hearts were procured under the condition of stable hemodynamics and enough oxygen after brain death(typeⅠ), fortyfour donor hearts were procured under the condition of brain death with acute hemorrhage and hypovolemia (typeⅡ), and 13 donor hearts were procured under the condition of brain death with cardiac arrest (typeⅢ). Twenty cases underwent standard transplantation procedure, one underwent total heart transplantation procedure and 40 underwent bicaval transplantation procedure. The donor heart cold ischemic period ranged from 52 to 347 min（92±31 min）, and 13 cases were more than 240 min. Results Two cases died of low cardiac output syndrome on 7th and 9th day after operation respectively, and their donor heart cold ischemic period were 327 and 293 min respectively. The rest of patients all recovered and discharged. One died of acute rejection on 18th month after operation because of rejecting immunosuppressive agents, and 1 died in traffic accident on 23rd month after transplantation. The rest 57 cases survived 6-59 months(mean 35 months), and had good life quality with NYHA cardiac function classification in 0-I grade. Conclusions Heart transplantation with donor aged over 40 may also have satisfactory results. Patients with endstage dilated cardiomyopathy can procure donor heartsfrom donors with heavy weight. Using different techniques to procure donor hearts may furthest reduce myocardial injury. Donor hearts which have been protected by myocardium protecting liquid for a long time should be used with caution.
Objective To investigate the protective effects of cardioplegic solution with creatine phosphate on donor heart preservation in rats, and the possibility of prolonging outofbody heart preservation in lack of blood supply to improve on transplantation quality. Methods Twenty Wistar rats were randomly divided into two groups, control group (n=10): pure St.ThomasⅡ cardioplegic solution was perfused to protect donor hearts; experimental group (n=10): St.ThomasⅡ cardioplegic solution with 2.5g/L sodium creatine phosphate was perfused to protect donor hearts. After 4 hours of refrigerated preservation, myocardial tissues were tested for adenosinetriphosphate(ATP) level and super oxide dismutase (SOD) activity. Cardiac ultrastructure and mitochondria swelling condition were monitored with light and electron microscopes. Results After the 4hour low temperature preservation of donor hearts, ATP content in experimental group cardiac tissue was significantly higher than that in control group (2.75±0.99μmol/mg vs. 1.77±0.86μmol/mg, Plt;0.05); SOD in experimental group cardiac tissue was significantly higher than that in control group（49.6±2.52 U/mg vs. 45.27±2.21 U/mg，Plt;0.05）. Electron microscopic inspection demonstrates that in the control group, chromatin condensed and dissolved inside the nuclear membrane; mitochondria ridge gap disappeared; myocardial cell pyknosis and mesenchymal vascular endothelia necrosis appeared. In contrast, myocardial cell nuclei remained in the center; sarcomere band structure was distinct; sarcoplasmic reticulum expanded and intercalated disk band structure was clear in experimental group. Conclusion Cardioplegic solution with creatine phosphate is able to enhance donor heart myocardial protection significantly.