Machine Perfusion of Donor Heart: State of the Art

Hatami, Sanaz; Freed, Darren H.

doi:10.1007/s40472-019-00251-4

Cited by 9 publications

(23 citation statements)

References 53 publications

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“…After the pioneering work of isolated (ex-situ)-perfused heart method by Cyon in 1866, the method was further adopted for perfusion of mammal heart by Langendorff in 1895 (3). With the introduction of isolated working heart preparation less than a century later in 1967 by Neely and Morgan, ex-situ heart perfusion (ESHP) has been since widely utilized for studying the heart (15).…”

Section: Ex-situ Thoracic Organ Perfusionmentioning

confidence: 99%

“…Formation of edema and tissue injury, as well as diminished functional status of the organ during extended exsitu perfusion periods, limit the optimal ex-situ preservation time, and create an obstacle for potential advantages of this preservation/evaluation method. Meanwhile, the implications of the artificial materials/surfaces used in ex-situ organ perfusion in development of cellular injury and stress has been mostly neglected (3,17,18).…”

Section: Ex-situ Thoracic Organ Perfusionmentioning

confidence: 99%

“…This may be partially related to the fact that the concept of clinical ESOP with modern technology as a method for preservation and potential recovery of donor heart and lung is still in its infancy. Moreover, there is incredible variability in the custom-built circuits used in experimental studies on ESOP, also affected by the size of the experimental animal model used (3,158) making it very difficult to evaluate/ compare these circuits and their individual components for induction of inflammation/oxidative stress during perfusion. While there are currently four different devices commercially available for clinical normothermic ESLP, there is only one for clinical normothermic ESHP (3,159).…”

Section: Targeting Inflammation and Oxidative Stress In Extracorporea...mentioning

confidence: 99%

“…Moreover, there is incredible variability in the custom-built circuits used in experimental studies on ESOP, also affected by the size of the experimental animal model used (3,158) making it very difficult to evaluate/ compare these circuits and their individual components for induction of inflammation/oxidative stress during perfusion. While there are currently four different devices commercially available for clinical normothermic ESLP, there is only one for clinical normothermic ESHP (3,159). Studies using clinically relevant platforms and circuits are necessary for evaluation of biocompatibility in ESOP setting in terms of reducing inflammation and oxidative stress.…”

Section: Targeting Inflammation and Oxidative Stress In Extracorporea...mentioning

confidence: 99%

“…During the recent couple of decades, this technology has been extended to ex-situ organ perfusion (ESOP) to improve the protection, availability, and assessment of the donor hearts and lungs. These technologies have, without a doubt, been revolutionary, leading to significant improvements in surgical treatments, patient management, and donated thoracic organ utilization (2,3). However, its application has met some limitations as well, with systemic inflammation and oxidative stress being among the most important challenges.…”

Section: Introductionmentioning

confidence: 99%

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Inflammation and Oxidative Stress in the Context of Extracorporeal Cardiac and Pulmonary Support

2022

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Extracorporeal circulation (ECC) systems, including cardiopulmonary bypass, and extracorporeal membrane oxygenation have been an irreplaceable part of the cardiothoracic surgeries, and treatment of critically ill patients with respiratory and/or cardiac failure for more than half a century. During the recent decades, the concept of extracorporeal circulation has been extended to isolated machine perfusion of the donor organ including thoracic organs (ex-situ organ perfusion, ESOP) as a method for dynamic, semi-physiologic preservation, and potential improvement of the donor organs. The extracorporeal life support systems (ECLS) have been lifesaving and facilitating complex cardiothoracic surgeries, and the ESOP technology has the potential to increase the number of the transplantable donor organs, and to improve the outcomes of transplantation. However, these artificial circulation systems in general have been associated with activation of the inflammatory and oxidative stress responses in patients and/or in the exposed tissues and organs. The activation of these responses can negatively affect patient outcomes in ECLS, and may as well jeopardize the reliability of the organ viability assessment, and the outcomes of thoracic organ preservation and transplantation in ESOP. Both ECLS and ESOP consist of artificial circuit materials and components, which play a key role in the induction of these responses. However, while ECLS can lead to systemic inflammatory and oxidative stress responses negatively affecting various organs/systems of the body, in ESOP, the absence of the organs that play an important role in oxidant scavenging/antioxidative replenishment of the body, such as liver, may make the perfused organ more susceptible to inflammation and oxidative stress during extracorporeal circulation. In the present manuscript, we will review the activation of the inflammatory and oxidative stress responses during ECLP and ESOP, mechanisms involved, clinical implications, and the interventions for attenuating these responses in ECC.

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Section: Ex-situ Thoracic Organ Perfusionmentioning

confidence: 99%

Section: Ex-situ Thoracic Organ Perfusionmentioning

confidence: 99%