PDF(Pubmed)
Abstract：
Heart transplantation remains the conventional treatment in end-stage heart failure, with static cold storage (SCS) being the standard technique used for donor preservation. Nevertheless, prolonged cold ischemic storage is associated with the increased risk of early graft dysfunction attributed to residual ischemia, reperfusion, and rewarming damage. In addition, the demand for the use of marginal grafts requires the development of new methods for organ preservation and repair. In this review, we focus on current knowledge and novel methods of donor preservation in heart transplantation. Hypothermic or normothermic machine perfusion may be a promising novel method of donor preservation based on the administration of cardioprotective agents. Machine perfusion seems to be comparable to cold cardioplegia regarding donor preservation and allows potential repair treatments to be employed and the assessment of graft function before implantation. It is also a promising platform for using marginal organs and increasing donor pool. New pharmacological cardiac repair treatments, as well as cardioprotective interventions have emerged and could allow for the optimization of this modality, making it more practical and cost-effective for the real world of transplantation. Recently, the use of triiodothyronine during normothermic perfusion has shown a favorable profile on cardiac function and microvascular dysfunction, likely by suppressing pro-apoptotic signaling and increasing the expression of cardioprotective molecules.
摘要：
心脏移植仍是终末期心力衰竭的常规治疗方法,静态冷藏（SCS）是用于供体保存的标准技术。然而，长时间的冷缺血储存与由于残余缺血引起的早期移植物功能障碍的风险增加有关。再灌注,和复温伤害。此外,对使用边缘移植物的需求需要开发新的器官保存和修复方法。在这次审查中,我们关注心脏移植中供体保存的最新知识和新方法。基于心脏保护剂的施用，低温或常温机器灌注可能是一种有前途的新颖的供体保存方法。在供体保存方面，机器灌注似乎与冷心脏停搏液相当，并且可以在植入前采用潜在的修复治疗方法并评估移植物功能。它也是使用边缘器官和增加供体库的有希望的平台。新的药物心脏修复治疗，以及心脏保护性干预措施已经出现，可以优化这种模式，使其对于移植的现实世界更加实用和具有成本效益。最近,在正常体温灌注期间使用三碘甲状腺原氨酸对心脏功能和微血管功能障碍具有良好的影响，可能通过抑制促凋亡信号和增加心脏保护分子的表达。
