Myocardial Functional Decline During Prolonged Ex Situ Heart Perfusion

Hatami, Sanaz; White, Christopher W.; Shan, Shubham; Haromy, Alois; Xiao, Qi; Ondrus, Martin; Kinnear, Alexandra; Himmat, Sayed; Michelakis, Evangelos D.; Nagendran, Jayan; Freed, Darren H.

doi:10.1016/j.athoracsur.2019.01.076

Cited by 30 publications

(34 citation statements)

References 25 publications

(35 reference statements)

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“…10 Ex vivo perfusion technology will continue to help with the long-distance transplant but is still imperfect as evidence in translational models where myocardial function deteriorates over time. 11 Further investigation is warranted to elucidate cellular pathways precipitating functional decline and the potential impact of pharmaceuticals aimed at mitigating ischemia-reperfusion injury. 12,13 It is reassuring to know this technology can support long-distance travel and positive outcomes can be achieved with OCS time greater than 17 h, especially in an organ meeting extended criteria donor status.…”

Section: Commentarymentioning

confidence: 99%

“…Ex vivo perfusion technology will continue to help with the long‐distance transplant but is still imperfect as evidence in translational models where myocardial function deteriorates over time 11 . Further investigation is warranted to elucidate cellular pathways precipitating functional decline and the potential impact of pharmaceuticals aimed at mitigating ischemia‐reperfusion injury 12,13 .…”

Section: Commentarymentioning

confidence: 99%

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Commentary: Planes, trains, and automobiles—Effective use of prolonged ex vivo heart preservation

Rotar

Krön

2021

Journal of Cardiac Surgery

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Section: Commentarymentioning

confidence: 99%

Section: Commentarymentioning

confidence: 99%

Commentary: Planes, trains, and automobiles—Effective use of prolonged ex vivo heart preservation

Rotar

Krön

2021

Journal of Cardiac Surgery

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“…Furthermore, this approach precludes in situ hemodynamic and functional evaluation of the potential donor heart under physiologic conditions and limits graft viability assessment to measuring venous and arterial lactate levels. A recent study using a porcine heart model demonstrated that ex situ perfusion might actually contribute to a decline in myocardial function …”

Section: Logistical Concernsmentioning

confidence: 99%

Ethical and logistical concerns for establishing NRP-cDCD heart transplantation in the United States

Parent

Moazami

Wall

et al. 2020

American Journal of Transplantation

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Controlled heart donation after circulatory determination of death (cDCD) is well established internationally with good outcomes and could be adopted in the United States to increase heart supply if ethical and logistical challenges are comprehensively addressed. The most effective and resource‐efficient method for mitigating warm ischemia after circulatory arrest is normothermic regional perfusion (NRP) in situ. This strategy requires restarting circulation after declaration of death according to circulatory criteria, which appears to challenge the legal circulatory death definition requiring irreversible cessation. Permanent cessation for life‐saving efforts must be achieved to assuage this concern and ligating principal vessels maintains no blood flow to the brain, which ensures natural progression to cessation of brain function. This practice—standard in some countries—raises unique concerns about prioritizing life‐saving efforts, informed authorization from decision‐makers, and the clinician's role in the patient's death. To preserve public trust, medical integrity, and respect for the donor, the donation conversation must not take place until after an un‐coerced decision to withdraw life‐sustaining treatment made in accordance with the patient's treatment goals. The decision‐maker(s) must understand cDCD procedure well enough to provide genuine authorization and the preservation/procurement teams must be kept separate from the clinical care team.

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“…MA coronary perfusion, placing the pump in synchronized pumping mode, adjusting the oncotic pressure of the perfusate, maintaining a stable lactate profile, and limiting the perfusion time to around 5 h. Beyond 5 h, the heart will still be perfused and protected; however, edema begins to more significantly affect early graft function, and this may increase the likelihood of requiring temporary mechanical support posttransplantation (Kaliyev et al 2019;Collins et al 2008). This effect has been seen in large animal studies demonstrating myocardial functional decline after long periods of machine perfusion (Hatami et al 2019). The other key element in the management of an OCS™ heart is that rapidly establishing sufficient perfusion after connecting the aortic cannula to heart is critical.…”

Section: Organ Care Systemmentioning

confidence: 99%