Recipient hypertonic saline infusion prevents cardiac allograft dysfunction.

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  • Additional Information
    • Source:
      Publisher: Mosby Country of Publication: United States NLM ID: 0376343 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-685X (Electronic) Linking ISSN: 00225223 NLM ISO Abbreviation: J Thorac Cardiovasc Surg Subsets: MEDLINE
    • Publication Information:
      Publication: St. Louis, MO : Mosby
      Original Publication: St. Louis.
    • Subject Terms:
      Fluid Therapy* ; Vasodilation* ; Ventricular Function, Left*; Coronary Vessels/*physiopathology ; Endothelium, Vascular/*physiopathology ; Heart Transplantation/*adverse effects ; Saline Solution, Hypertonic/*administration & dosage ; Ventricular Dysfunction, Left/*prevention & control; Allografts ; Animals ; Cardiopulmonary Bypass/adverse effects ; Disease Models, Animal ; Female ; Infusions, Intravenous ; Interleukin-2/metabolism ; Interleukin-6/metabolism ; Lung/metabolism ; Lung/pathology ; Lung Injury/etiology ; Lung Injury/metabolism ; Lung Injury/pathology ; Lung Injury/prevention & control ; Sus scrofa ; Tumor Necrosis Factor-alpha/metabolism ; Ventricular Dysfunction, Left/etiology ; Ventricular Dysfunction, Left/physiopathology
    • Abstract:
      Objective: Hypertonic saline (HTS) has potent immune and vascular effects. We assessed recipient pretreatment with HTS on allograft function in a porcine model of heart transplantation and hypothesized that HTS infusion would limit endothelial and left ventricular (LV) dysfunction following transplantation.
      Methods: Heart transplants were performed after 6 hours of cold ischemic storage. Recipient pigs were randomized to treatment with or without HTS (7.5% NaCl) before cardiopulmonary bypass (CPB). Using a myograft apparatus, coronary artery endothelial-dependent (Edep) and -independent (Eind) relaxation was assessed. LV performance was determined using pressure-volume loop analysis. Pulmonary interleukin (IL)-2, IL-6, and tumor necrosis factor (TNF)-α expression was measured.
      Results: Weaning from CPB and LV performance after transplantation were improved in HTS-treated animals. Successful weaning from CPB was greater in the HTS-treated hearts (8 of 8 vs 2 of 8; P < .05). Mean LV functional recovery was improved in the HTS-treated animals, as assessed by preload recruitable stroke work (65 ± 10% vs 27 ± 10%; P < .001) and end-systolic elastance (55 ± 7% vs 37 ± 4%; P < .001). Treatment with HTS resulted in improved Edep (mean maximum elastance [Emax], 56 ± 5% vs 37 ± 7%; P < .001) and Eind (mean Emax%, 77 ± 6% vs 52 ± 4%; P < .001) vasorelaxation compared with control. Pulmonary expression of IL-2, IL-6, and TNF-α increased following transplantation, whereas HTS therapy attenuated IL production (P < .001). Transplantation increased plasma TNF-α levels and LV TNF-α expression, whereas HTS prevented this up-regulation (P < .001).
      Conclusions: Recipient HTS pretreatment preserves allograft vasomotor and LV function, and HTS therapy limits CPB-induced injury. HTS may be a novel recipient intervention to prevent graft dysfunction.
      (Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
    • Comments:
      Comment in: J Thorac Cardiovasc Surg. 2019 Feb;157(2):628-629. (PMID: 30174127)
      Comment in: J Thorac Cardiovasc Surg. 2019 Feb;157(2):626-627. (PMID: 30174129)
    • Contributed Indexing:
      Keywords: heart transplantation; myocardial ischemia/reperfusion injury; myocardial protection
    • Accession Number:
      0 (Interleukin-2)
      0 (Interleukin-6)
      0 (Saline Solution, Hypertonic)
      0 (Tumor Necrosis Factor-alpha)
    • Publication Date:
      Date Created: 20180820 Date Completed: 20200224 Latest Revision: 20200224
    • Publication Date:
      20221213
    • Accession Number:
      10.1016/j.jtcvs.2018.07.018
    • Accession Number:
      30121134