A Case of Dramatic Sarcomere Disarray in a Marginal Donor Heart Explanted Soon After Cardiac Arrest: Possible Rearrangement After Ex Vivo Perfusion

Bonetti, Antonella; Sponga, Sandro; Livi, Ugolino; Ortolani, Fulvia

doi:10.1097/tp.0000000000003795

Cited by 3 publications

(6 citation statements)

References 4 publications

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Section: Nmp Employmentmentioning

confidence: 99%

“…Donor hearts, selected according to expanded-criteria, appear to be best treated by NMP, especially when severe hypotension or cardiac arrest occurs during the retrieval phase and since this technique could hamper the negative effect of cold storage on ultracellular cardiac function ( 42 ).…”

Section: Nmp Employmentmentioning

confidence: 99%

“…After in situ reperfusion during HTx, hearts preserved with ICS are frequently affected by myocardial injury, with damage of contractile myofilaments and organelles, including mitochondria. The ex situ perfusion with OCS is reported to be effective in reconditioning donor hearts, that are maintained metabolically active and able to heal ultrastructure changes (28,42). Donor hearts, selected according to expanded-criteria, appear to be best treated by NMP, especially when severe hypotension or cardiac arrest occurs during the retrieval phase and since this technique could hamper the negative effect of cold storage on ultracellular cardiac function (42).…”

Section: To Recover the Injured Graftmentioning

confidence: 99%

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Graft preservation in heart transplantation: current approaches

Lechiancole

Sponga

Benedetti

et al. 2023

Front. Cardiovasc. Med.

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Heart transplantation (HTx) represents the current best surgical treatment for patients affected by end-stage heart failure. However, with the improvement of medical and interventional therapies, the population of HTx candidates is increasingly old and at high-risk for mortality and complications. Moreover, the use of “extended donor criteria” to deal with the shortage of donors could increase the risk of worse outcomes after HTx. In this setting, the strategy of donor organ preservation could significantly affect HTx results. The most widely used technique for donor organ preservation is static cold storage in ice. New techniques that are clinically being used for donor heart preservation include static controlled hypothermia and machine perfusion (MP) systems. Controlled hypothermia allows for a monitored cold storage between 4°C and 8°C. This simple technique seems to better preserve the donor heart when compared to ice, probably avoiding tissue injury due to sub-zero °C temperatures. MP platforms are divided in normothermic and hypothermic, and continuously perfuse the donor heart, reducing ischemic time, a well-known independent risk factor for mortality after HTx. Also, normothermic MP permits to evaluate marginal donor grafts, and could represent a safe and effective technique to expand the available donor pool. However, despite the increasing number of donor hearts preserved with these new approaches, whether these techniques could be considered superior to traditional CS still represents a matter of debate. The aim of this review is to summarize and critically assess the available clinical data on donor heart preservation strategies employed for HTx.

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Section: Nmp Employmentmentioning

confidence: 99%

Section: Nmp Employmentmentioning

confidence: 99%

Section: To Recover the Injured Graftmentioning

confidence: 99%

See 1 more Smart Citation

Graft preservation in heart transplantation: current approaches

Lechiancole

Sponga

Benedetti

et al. 2023

Front. Cardiovasc. Med.

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“…HTx was performed using the bicaval anastomosis technique and immunosuppression therapy was standardized with steroids, calcineurin inhibitors and mycophenolate mofetil. Postoperative and long-term followup protocols at the University Hospital of Udine have been previously published and have remained unchanged during the study period [13][14][15][16][17]. In Hannover, all HTx recipients underwent triple immunosuppressive therapy with tacrolimus, prednisolone and mycophenolate mofetil.…”

Section: Htx Proceduresmentioning

confidence: 99%

Heart Transplantation in High-Risk Recipients Employing Donor Marginal Grafts Preserved With Ex-Vivo Perfusion

Sponga

Vendramin²,

Salman³

et al. 2023

Transpl Int

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Extending selection criteria to face donor organ shortage in heart transplantation (HTx) may increase the risk of mortality. Ex-vivo normothermic perfusion (EVP) limits ischemic time allowing assessment of graft function. We investigated the outcome of HTx in 80 high-risk recipients transplanted with marginal donor and EVP-preserved grafts, from 2016 to 2021. The recipients median age was 57 years (range, 13–75), with chronic renal failure in 61%, impaired liver function in 11% and previous cardiac surgery in 90%; 80% were mechanically supported. Median RADIAL score was 3. Mean graft ischemic time was 118 ± 25 min, “out-of-body” time 420 ± 66 min and median cardiopulmonary bypass (CPB) time 228 min (126–416). In-hospital mortality was 11% and ≥moderate primary graft dysfunction 16%. At univariable analysis, CPB time and high central venous pressure were risk factors for mortality. Actuarial survival at 1 and 3 years was 83% ± 4%, and 72% ± 7%, with a median follow-up of 16 months (range 2–43). Recipient and donor ages, pre-HTx extracorporeal life support and intra-aortic balloon pump were risk factors for late mortality. In conclusion, the use of EVP allows extension of the graft pool by recruitment of marginal donors to successfully perform HTx even in high-risk recipients.

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“…After in-situ reperfusion during HTx, hearts preserved with cold storage are frequently affected by myocardium injury, with damaged contractile myofilaments and organelles including mitochondria. The ex-situ perfusion with OCS is reported to be effective in reconditioning donor hearts, that are maintained metabolically active and able to heal ultrastructural changes 17,34 . Expanded-criteria donor hearts appear to be best treated by NMP, especially when severe hypotension or cardiac arrest occurs during the retrieval phase and could hamper the negative effect of cold storage on ultracellular cardiac function 34 .…”

Section: To Recover the Injured Graftmentioning

confidence: 99%