Myocardial perfusion characteristics during machine perfusion for heart transplantation

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

“…Although this technique has been shown in previous studies to be superior to standard cold storage [6,7], there is the potential for aortic valve incompetence, resulting in inconsistent perfusion and nonnutrient flow [8]. Under hypothermic conditions, at standard ischemic intervals, the heart would essentially undergo static cold storage; however, for longer ischemic times, normothermic perfusion, and procurement of extended criteria hearts, nonnutrient flow could have significant implications for graft function.…”

“…Under hypothermic conditions, at standard ischemic intervals, the heart would essentially undergo static cold storage; however, for longer ischemic times, normothermic perfusion, and procurement of extended criteria hearts, nonnutrient flow could have significant implications for graft function. We previously demonstrated that the use of an initially high loading flow rate, followed by normal flow rates of perfusion solution, may result in better apposition of the aortic valve leaflets and potentially avoid this problem [8]. However, it is difficult to assess and verify adequate leaflet closure during machine perfusion.…”

1H magic angle spinning magnetic resonance spectroscopy for monitoring machine-perfused canine donor heart preservation prior to transplantation

“…1 We have previously utilized 1 H magnetic resonance spectroscopy (MRS) to examine metabolic differences between hearts stored by static or machine perfusion techniques and we identified differences in metabolic parameters (lactate/alanine ratio) that were associated with reduced cardiac injury, decreased myocyte apoptosis and improved reperfusion function, 2,3 and also differentiated between perfused hearts subjected to high and low nutrient flow during machine perfusion. 4 Microsphere analysis and 1 H MRS of cardiac tissue in these experiments demonstrated uniform ventricular perfusion, suggesting that data from a single sample may be able to predict myocardial preservation.…”

Machine perfusion for cardiac allograft preservation

“…Multiple factors are likely involved, including perfusate composition, perfusion pressure, and flow rates. Perfusion at higher flow rates through the myocardium appears to increase the risk of myocardial edema development [58]. Therefore, device manufacturers may have to find a balance between higher flows that supply more oxygen and substrate to the heart and lower flows that decrease the risk of myocardial edema development.…”