A cardioprotective preservation strategy employing ex vivo heart perfusion facilitates successful transplant of donor hearts after cardiocirculatory death

A whole blood–based perfusate provides superior preservation of myocardial function during ex vivo heart perfusion

“…13 Briefly, a normal-phase high-performance liquid chromatography of phospholipids was performed on a 2.7-mm Supelco column in a Ex vivo heart perfusion circuit: A, venous reservoir; B, centrifugal pumps; C, oxygenator/heat exchanger; D, oxygen/medical air source; E, leukocyte filter; F, flow probe. LA, left atrium; PA, pulmonary artery.…”

Heart Transplantation From Donation After Circulatory Death Donors

“…[3][4][5][6][7] Heart transplantation from DCD donors is not new. The donors for the first human heart transplants performed in the late 1960s belonged to what would currently be defined as Maastrich Category 4 DCD donors.…”

“…Several groups have demonstrated that it is possible to "postcondition' the DCD heart by modifying the initial flush solution, thereby increasing the heart's tolerance to warm ischemia. 4,7 As with other organs, there is active research investigating machine perfusion of the heart using both hypothermic crystalloid solutions and normothermic blood-based perfusion. Both approaches have been shown to be superior to cold storage in preclinical models.…”

“…Both approaches have been shown to be superior to cold storage in preclinical models. 5,7,11,12 A clear advantage of normothermic ex vivo perfusion is that it allows the viability of the DCD heart to be assessed before heart transplantation. 11 An additional advantage is that there already exists a normothermic ex vivo perfusion device that has been approved for clinical use that has undergone extensive clinical evaluation in the preservation of standard and extended criteria hearts retrieved from donors who have undergone brain death.…”

Optimization of Cooling Protocols for Hearts Destined for Transplantation

“…White et al tried to minimize myocardial injury and improve short-term posttransplant function by using initial reperfusion with a tepid adenosine-lidocaine cardioplegia and continuous myocardial perfusion [27]. Many of the experimental research studies in this field have been focused on the cooling solution.…”