Effects of Antegrade and Retrograde Machine Perfusion Preservation on Cardiac Function After Transplantation in Canines

Hypothermic, oxygenated perfusion (HOPE) provides cardioprotection via succinate oxidation prior to normothermic perfusion in a rat model of donation after circulatory death (DCD)

“…Our functional results are in accordance with previously reported effects of cold, oxygenated perfusion vs CSS in the heart 19,26 , albeit these previous reports used shorter warm ischemic durations and procurement protocols that substantially deviate from current clinical protocols. Furthermore, neither of these studies investigated specific contributions of oxygenation and/or perfusion to cardioprotection 19,26 . In this study, we have identified mechanisms of HOPE that contribute to improved postischemic recovery, as discussed below.…”

“…However, our clinically available NO donor (GTN) was suspended in a glucose‐containing solution, which provided an exogenous energy substrate during the cardioplegic flush and the hypothermic perfusion/storage period. Previously reported prolonged HOPE in cardiac DCD models has been performed with either cardioplegic solutions poor in specific energy substrates 26 or with a solution containing glucose 19 . The observation of cardioprotection in both cases suggests that HOPE may also work via oxidation of endogenous energy substrates.…”

“…As several minutes are required for preparation of the graft for NMP, including cannulation of the aorta for perfusion and of the pulmonary artery for drainage, 7 antegrade coronary perfusion may not be possible throughout the entire procedure. Options to liberate the aorta for cannulation, but permit perfusion, would be intermittent oxygenated perfusion 34 or potentially retrograde perfusion via the coronary sinus 26 . In this rat model of DCD, heparinization was required to achieve effective heart reperfusion and prevent from clot formation; however, its use in clinical DCD settings is prohibited in some jurisdictions.…”

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

“…Inotropic requirements for these hearts were modest and similar to previously published results from our laboratory after a conventional donor ischemic interval. 23 Myocardial edema is a potential concern with crystalloid perfusion of donor hearts, although its effect on reperfusion function is unclear. RP hearts in the current study experienced significant weight gain during storage; however, no functional impairment was observed after separation from CPB despite the noted weight gain.…”