PMID- 29382512
OWN - NLM
STAT- MEDLINE
DCOM- 20190528
LR  - 20190528
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Linking)
VI  - 105
IP  - 6
DP  - 2018 Jun
TI  - Steroids Limit Myocardial Edema During Ex Vivo Perfusion of Hearts Donated After 
      Circulatory Death.
PG  - 1763-1770
LID - S0003-4975(18)30061-4 [pii]
LID - 10.1016/j.athoracsur.2018.01.004 [doi]
AB  - BACKGROUND: Normothermic ex vivo heart perfusion (EVHP) has been shown to improve 
      the preservation of hearts donated after circulatory arrest and to facilitate 
      clinical successful transplantation. Steroids are added to the perfusate solution 
      in current clinical EVHP protocols; however, the impact of this approach on donor 
      heart preservation has not been previously investigated. We sought to determine 
      the impact of steroids on the inflammatory response and development of myocardial 
      edema during EVHP. METHODS: Thirteen pigs were anesthetized, mechanical 
      ventilation was discontinued, and a hypoxemic cardiac arrest ensued. A 15-minute 
      warm-ischemic standoff period was observed, and then hearts were resuscitated 
      with a cardioplegic solution. Donor hearts were then perfused ex vivo in a 
      normothermic beating state for 6 hours with 500 mg of methylprednisolone 
      (steroid: n = 5) or without (control: n = 8). RESULTS: The addition of steroids 
      to the perfusate solution reduced the generation of proinflammatory cytokines 
      (interleukin-6, -8, -1beta, and tumor necrosis factor-alpha) and the development of 
      myocardial edema during EVHP (percentage of weight gain: control = 26% +/- 7% 
      versus steroid = 16% +/- 10%, p = 0.049). Electron microscopy suggested less 
      endothelial cell edema in the steroid group (injury score: control = 1.8 +/- 0.2 
      versus steroid = 1.2 +/- 0.2, p = 0.06), whereas perfusate troponin-I (control = 
      11.9 +/- 1.9 ng/mL versus steroid = 9.5 +/- 2.4 ng/mL, p = 0.448) and myocardial 
      function were comparable between the groups. CONCLUSIONS: The addition of 
      methylprednisolone to the perfusion solution minimizes the generation of 
      proinflammatory cytokines and development of myocardial edema during normothermic 
      ex vivo perfusion of hearts donated after circulatory arrest.
CI  - Copyright (c) 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All 
      rights reserved.
FAU - Sandha, Jaskiran K
AU  - Sandha JK
AD  - Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, 
      Canada.
FAU - White, Christopher W
AU  - White CW
AD  - Division of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada.
FAU - Muller, Alison
AU  - Muller A
AD  - Department of Physiology, University of Alberta, Edmonton, Alberta, Canada.
FAU - Avery, Emma
AU  - Avery E
AD  - Institute of Cardiovascular Sciences, St. Boniface Research Center, Winnipeg, 
      Manitoba, Canada.
FAU - Thliveris, James
AU  - Thliveris J
AD  - Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, 
      Manitoba, Canada.
FAU - Dixon, Ian M C
AU  - Dixon IMC
AD  - Institute of Cardiovascular Sciences, St. Boniface Research Center, Winnipeg, 
      Manitoba, Canada.
FAU - Arora, Rakesh C
AU  - Arora RC
AD  - Institute of Cardiovascular Sciences, St. Boniface Research Center, Winnipeg, 
      Manitoba, Canada; Department of Surgery, Max Rady College of Medicine, University 
      of Manitoba, Winnipeg, Manitoba, Canada.
FAU - Tian, Ganghong
AU  - Tian G
AD  - National Research Council Institute for Biodiagnostics, Winnipeg, Manitoba, 
      Canada.
FAU - Hryshko, Larry V
AU  - Hryshko LV
AD  - Institute of Cardiovascular Sciences, St. Boniface Research Center, Winnipeg, 
      Manitoba, Canada.
FAU - Nagendran, Jayan
AU  - Nagendran J
AD  - Division of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada.
FAU - Freed, Darren H
AU  - Freed DH
AD  - Division of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada; 
      Department of Physiology, University of Alberta, Edmonton, Alberta, Canada; 
      Institute of Cardiovascular Sciences, St. Boniface Research Center, Winnipeg, 
      Manitoba, Canada; Department of Surgery, Max Rady College of Medicine, University 
      of Manitoba, Winnipeg, Manitoba, Canada; Department of Biomedical Engineering, 
      University of Alberta, Edmonton, Alberta, Canada. Electronic address: 
      dhfreed@ualberta.ca.
LA  - eng
GR  - Canadian Institutes of Health Research/International
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20180131
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
RN  - 0 (Cardioplegic Solutions)
RN  - X4W7ZR7023 (Methylprednisolone)
SB  - IM
MH  - Animals
MH  - Cardioplegic Solutions/*pharmacology
MH  - Disease Models, Animal
MH  - Edema, Cardiac/*prevention & control
MH  - Graft Survival
MH  - Heart Arrest
MH  - Heart Transplantation/methods
MH  - Humans
MH  - Methylprednisolone/*pharmacology
MH  - Organ Preservation/*methods
MH  - Random Allocation
MH  - Reference Values
MH  - Sensitivity and Specificity
MH  - Swine
EDAT- 2018/02/01 06:00
MHDA- 2019/05/29 06:00
CRDT- 2018/02/01 06:00
PHST- 2017/05/02 00:00 [received]
PHST- 2017/10/21 00:00 [revised]
PHST- 2018/01/03 00:00 [accepted]
PHST- 2018/02/01 06:00 [pubmed]
PHST- 2019/05/29 06:00 [medline]
PHST- 2018/02/01 06:00 [entrez]
AID - S0003-4975(18)30061-4 [pii]
AID - 10.1016/j.athoracsur.2018.01.004 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2018 Jun;105(6):1763-1770. doi: 
      10.1016/j.athoracsur.2018.01.004. Epub 2018 Jan 31.