Experience of heart transplantation with an extended cold ischemic time of donor heart

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Cardiac injury remains one of the most complex conditions in emergency surgery. Only 6% of patients with penetrating heart wounds manage to be delivered to the operating room for surgery, and the mortality rate is still extremely high. Unfortunately, such emergency interventions are often performed in institutions lacking the ability to provide the full range of reconstructive techniques, resulting in suboptimal correction and a high risk of developing postoperative complications. This paper describes a clinical case of successful repair of multiple stab wounds to the heart with concomitant anterior descending artery injury followed by severe heart failure requiring biventricular mechanical circulatory support.

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Clinical case of long-term mechanical circulatory support in a patient with biventricular heart failure after cardiac stab wound

Sirota,

Zhulkov,

Makaev

et al. 2023

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Results of a study of the effectiveness of direct coronary oxygen persufflation as a donor heart conditioning method

Zhulkov

Сирота

Зыков

et al. 2022

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Objective: to evaluate the technical feasibility as well as functional, metabolic and structural integrity of donor heart myocardium after 4 hours of direct intracoronary oxygen persufflation in an experiment.Materials and methods. Mini-pig siblings aged 3 months with a body weight of23-36 kg were used as the experimental model. In the control group (n = 8), donor hearts were cold preserved by injecting 2 liters of Bretschneider cardioplegic solution (Custodiol®, Germany, HTK) into the aortic root. In the experimental group (n = 8), modified HTK solution (with 40 mg/L hyaluronidase added) was used to initiate cardioplegia, then moistened carbogen (95% O2, 5% CO2) was injected into the ascending aorta, maintaining 40-45 mm Hg aortic root pressure. The hearts were stored in an mHTK solution at 0-4 °С. After 3 hours of donor heart preservation, orthotopic heart transplantation (OHTx) was performed. In the post-transplant period, we studied central hemodynamic parameters, myocardial oxygen consumption, level of myocardial ischemia markers (troponin I, Tnl; creatine phosphokinase-MB, CPK-MB; lactate dehydrogenase, LDH), and histological signs of structural cellular injury.Results. Sixteen OHTx surgeries were performed during the study. At 120 minutes after restoration of spontaneous cardiac activity, cardiac output was 2.99 [4.85; 3.17] L/min and 2.48 [2.04; 2.92] L/min (p > 0.05) in the control and experimental groups, respectively. Changes in LDH, TnI and lactate levels in the blood flowing from the coronary sinus were significantly higher in the early reperfusion period. However, there was no statistically significant difference between the groups (p > 0.05). Myocardial oxygen consumption in the control and experimental groups was 8.2 [7.35; 9.35] ml-O2/min/100 g and 7.7 [6.75; 10.12] ml-O2/min/100 g, respectively (p > 0.05). Morphological examinations also showed no significant myocardial ischemia injury in the persufflation group compared to the control group.Conclusion. The experiment showed the technical feasibility and safety of direct intracoronary oxygen persufflation for 4 hours at the ex vivo donor heart conditioning stage. At the same time, experimental data showed no significant advantages of coronary persufflation over the standard protocol of cold preservation of donor heart with Bretschneider cardioplegic solution.

Surgical technique for explantation of a functioning cardiopulmonary complex in an experiment

Zhulkov,

Zykov,

Makaev

et al. 2023

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Objective: to develop and approve the surgical technique for explantation of a functioning cardiopulmonary complex under normothermic autoperfusion.Materials and methods. Landrace pigs were used as the experimental model for a series of acute experiments (n = 10). During the experiment, invasive pressure in the cavities of the heart and main arteries, blood gas composition, and myocardial contractility were monitored. The functioning cardiopulmonary complex was explanted through a median sternotomy. The explanted complex was conditioned at 37–38 °C for 6 hours.Results. In the course of a series of experiments, it was shown that stable operation of the isolated heart-lung complex ex vivo for 6 hours was fundamentally possible provided that the parameters of the basic homeostasis constants are maintained. The technological solutions used made it possible to ensure safe hemodynamic and anatomical isolation of the working cardiopulmonary complex.Conclusion. The developed protocol for isolating a functioning cardiopulmonary complex allows to provide stable graft function for 6 hours under normothermic autoperfusion. Implementation of this concept in the development of transport systems would significantly facilitate their design and eliminate the use of expensive components. This would contribute to widespread introduction into clinical practice.