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In transplantation, there has always been an acute problem of the discrepancy between the number of donor organs and the number of recipients, including donor hearts. There are various ways to increase the pool of donor organs, one of them is the use of asystolic or non-heart-beating donors. Due to poor myocardial tolerance of ischemia during the asystole period, as well as because of the difficulties in diagnosing cardiac diseases of the asystolic donor, which can be contraindication to transplantation. Therefore, an in-depth study of the state of the myocardium in asystolic donors is required. Currently, there is no generally accepted protocol for working with asystolic heart donors. This protocol should include methods of heart conditioning and assessing of myocardium state. For its development we need more experimental and preclinical studies. A protocol for such a study is proposed. The modeling of an asystolic donor using rats is described on the basis of experimental work carried out by a team of authors. The article describes the following technical aspects: anesthetic guidance, asystole detection criterion, maintaining the rat body temperature in accordance with the human body temperature during cardiac arrest, surgical aspects of performing the main experimental model. The Langendorff model of isolated cardiac perfusion was chosen as the main model for assessing the state of the myocardium of a small laboratory animal. Intra-left ventricular pressure, volume of coronary blood flow, heart rate and the presence of post-reperfusion arrhythmias were selected as criteria for assessing the state of donor hearts. Assessment of the volume of damage to the donor heart is carried out using triphenyltetrazolium chloride staining of the donor organ.
In transplantation, there has always been an acute problem of the discrepancy between the number of donor organs and the number of recipients, including donor hearts. There are various ways to increase the pool of donor organs, one of them is the use of asystolic or non-heart-beating donors. Due to poor myocardial tolerance of ischemia during the asystole period, as well as because of the difficulties in diagnosing cardiac diseases of the asystolic donor, which can be contraindication to transplantation. Therefore, an in-depth study of the state of the myocardium in asystolic donors is required. Currently, there is no generally accepted protocol for working with asystolic heart donors. This protocol should include methods of heart conditioning and assessing of myocardium state. For its development we need more experimental and preclinical studies. A protocol for such a study is proposed. The modeling of an asystolic donor using rats is described on the basis of experimental work carried out by a team of authors. The article describes the following technical aspects: anesthetic guidance, asystole detection criterion, maintaining the rat body temperature in accordance with the human body temperature during cardiac arrest, surgical aspects of performing the main experimental model. The Langendorff model of isolated cardiac perfusion was chosen as the main model for assessing the state of the myocardium of a small laboratory animal. Intra-left ventricular pressure, volume of coronary blood flow, heart rate and the presence of post-reperfusion arrhythmias were selected as criteria for assessing the state of donor hearts. Assessment of the volume of damage to the donor heart is carried out using triphenyltetrazolium chloride staining of the donor organ.
Introduction. In transplantology, there has always been a problem of organ donor shortage, especially hearts. One of the possible ways to increase the pool of donor hearts is to use donors with circulatory arrest, however irreversible changes in the myocardium after circulatory arrest progress rapidly, which significantly complicates the use of a heart removed from an asystolic donor for transplantation. Objective. To evaluate the effectiveness of hypothermic perfusion of visceral cavities (HPVC) as a method of prolonging the viability of the myocardium of the donor heart during asystole. Materials and methods. The experiments were performed on male rats weighing 200–250 g. The animals were divided into 5 groups, deepening on the duration of HPVC, carried out after a 10-minute period of normothermal asystole: control – 0 min. HPVC and groups with HPVC lasting 30, 60, 90 and 120 min. After complete of perfusion of the heart cavities, they were connected to a Langendorff apparatus to evaluate functional parameters and then determine the volume of necrosis. Results. By the tenth minute of the asystole, the core temperature of the rats’ body was 37.2 ± 0.3 °C. The size of necrosis in the control group was 4.1± 0.6 %. In the groups with a duration of HPVC of 30, 60, and 90 minutes, the size of necrosis was significantly higher than in the control (p<0.05), and was 13.4±3.6 %, 10.3±4.4 % and 14.1±3.4 %, respectively, but there were no difference between these groups. There was a significant increase of the necrosis size in the group with HPVC lasting 120 min compared with the HPVC lasting 90 minutes (24.2±7.1 %, p><0.05). Conclusions. Cold perfusion of the visceral cavities of an asystolic donor, initiated 10 minutes after circulatory arrest, can significantly slow the progression of irreversible myocardial damage in up to 90 minutes, which can expand the potential for the use of hearts from asystolic donors.>< 0.05), and was 13.4±3.6 %, 10.3±4.4 % and 14.1±3.4 %, respectively, but there were no difference between these groups. There was a significant increase of the necrosis size in the group with HPVC lasting 120 min compared with the HPVC lasting 90 minutes (24.2±7.1 %, p< 0.05). Conclusions. Cold perfusion of the visceral cavities of an asystolic donor, initiated 10 minutes after circulatory arrest, can significantly slow the progression of irreversible myocardial damage in up to 90 minutes, which can expand the potential for the use of hearts from asystolic donors.
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