The energy metabolism in the right and left ventricles of human donor hearts across transplantation

Objective: Brain death appears to predominantly affect the right ventricle (RV) and right ventricular failure is a common complication of clinical cardiac transplantation. It is not clear to what extent myocardial energy stores are affected in the operative sequence. We aimed to describe the time-de...

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Published in:European journal of cardio-thoracic surgery 2003-04, Vol.23 (4), p.503-512
Main Authors: Stoica, Serban C., Satchithananda, Duwarakan K., Atkinson, Carl, White, Paul A., Redington, Andrew N., Goddard, Martin, Kealey, Terence, Large, Stephen R.
Format: Article
Language:English
Subjects:
Adult
Brain death
Brain Death - metabolism
Endothelium
Endothelium, Vascular - metabolism
Energy Metabolism
Energy stores
Heart transplantation
Heart Transplantation - physiology
Heart Ventricles - metabolism
Humans
Middle Aged
Myocardial contractility
Myocardial Contraction
Myocardial Ischemia - metabolism
Myocardial Reperfusion
Myocardium - metabolism
Phosphates - metabolism
Time Factors
Transplantation, Homologous
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Summary:Objective: Brain death appears to predominantly affect the right ventricle (RV) and right ventricular failure is a common complication of clinical cardiac transplantation. It is not clear to what extent myocardial energy stores are affected in the operative sequence. We aimed to describe the time-dependent variation in high energy phosphate (HEP) metabolism of the two ventricles, and the relationship with endothelial activation and postoperative functional recovery. Methods: Fifty-two human donors had serial biopsies from the RV and the left ventricle (LV) at (1) initial evaluation, (2) after haemodynamic optimisation, (3) end of cold ischaemia, (4) end of warm ischaemia, (5) reperfusion, and (6) at 1 week postoperatively. HEP was measured by chemiluminescence in biopsies 1–5 and adhesion molecules (P-selectin, E-selectin, VCAM-1) and thrombomodulin were analysed by immunohistochemistry in biopsies 5–6. Seventeen donors and five recipients had RV intraoperative pressure–volume recordings by a conductance catheter. Six patients served as live controls. Results: Brain death did not affect HEP metabolism quantitatively. There was no difference between the RV and LV at any time point, but significant time-dependent changes were observed. The RV was prone to HEP depletion at retrieval, with ATP/ADP falling from 3.89 to 3.13, but recovered during cold ischaemia. During warm ischaemia the ATP/ADP ratio fell by approximately 50%, from 5.48 for the RV and 4.26 for the LV, with partial recovery at reperfusion (P
ISSN:1010-7940
1873-734X
DOI:10.1016/S1010-7940(03)00019-8