Continuous perfusion of donor hearts with oxygenated blood cardioplegia improves graft function

Abstract

Summary Donor hearts cannot be preserved beyond 6 h using cold storage (CS). Improving preservation methods may permit prolonged storage of donor heart. We compared graft function in large animal model after prolonged preservation (8 h) using continuous perfusion (CP) and CS method. Twenty‐four miniature pigs were used as donors and recipients. Donor hearts were either stored in University of Wisconsin solution (UW solution) for 8 h at 0–4 °C (CS group, n = 6) or were continuously perfused with oxygenated blood cardioplegia at 26 °C for 8 h (CP group, n = 6). After preservation, hearts were transplanted into recipients and reperfused for 3 h. Left ventricular (LV) function, cardiac output (CO), malondialdehyde (MDA) and adenosine triphosphate (ATP) levels, and water content were measured. Although water content of CP hearts was higher than that of CS, LV contractility and diastolic function of CP hearts were superior to those of CS. In addition, CP hearts performed better than CS hearts on CO in working heart state. ATP was better preserved and MDA levels were lower in CP hearts compared with those of CS (P < 0.0001). Donor hearts can be preserved longer using continuous perfusion with oxygenated blood cardioplegia and this method prevents time‐dependent ischemic injury.

Intermediate outcomes with ex-vivo allograft perfusion for heart transplantation

“…Findings of decreased oxidative and myocardial injury markers, improved microvascular function and superior myocardial ultrastructure highlight the advantages of continuous normothermic perfusion. 24,[30][31][32] Currently as the only commercially available mobile cardiac perfusion device, the Organ Care System aims to reduce cold ischemia time, minimize myocardial dysfunction, and diminish constraints of procurement distances, thereby optimizing donor utilizations and geographic usage variabilities. Its initial evaluation in the PROCEED II trial assessed clinical outcomes of the Organ Care System compared with standard cold storage, and demonstrated 30-day mortality rates comparable to those of standard cold storage therapy.…”

Metabolic characteristics of human hearts preserved for 12 hours by static storage, antegrade perfusion, or retrograde coronary sinus perfusion

“…At least two previously published reperfusion experiments suggest that this weight increase is not necessarily associated with worse reperfusion cardiac function in organs that maintain satisfactory indices of oxidative metabolism. 19,20 This may be because, as Amirhamzeh et al have suggested, hydrostatic edema resolves when systolic forces return interstitial fluid to the intravascular space after reperfusion, 19 as long as endothelial integrity is maintained. Our own experience in a large animal model of machine perfusion preservation over shorter intervals also demonstrated that despite significant weight gain during the storage interval, myocardial function after implantation was not affected and myocardial water content after reperfusion was not increased.…”

Successful transplantation in canines after long-term coronary sinus machine perfusion preservation of donor hearts

“…24,25 Hearts in the current study were reperfused for 60 minutes before weaning from CPB, which may have facilitated this process. Outcomes might have been different had we used a shorter reperfusion period.…”