Normothermic Ex Situ Heart Perfusion in Working Mode: Assessment of Cardiac Function and Metabolism

Hatami, Sanaz; White, Christopher W.; Ondrus, Martin; Xiao, Qin; Buchko, Max; Himmat, Sayed; Lin, Lily; Cameron, Katie; Nobes, David S.; Chung, Hyun‐Joong; Nagendran, Jayan; Freed, Darren H.

doi:10.3791/58430-v

Cited by 6 publications

(15 citation statements)

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“…The supporting heart perfusion circuit was constructed using two centrifugal pumps (ROTAFLOW, MAQUET), an arterial line filter (LivaNova), a membrane oxygenator (D 905, LivaNova), and a custom-built organ chamber containing a silicone support membrane with integrated Ao, La, and Pa cannulas. The procured hearts were perfused in a semihorizontal position on the supporting membrane in a slightly downward angle (~20°) 7 ( Figure 1 , C and D ).…”

Section: Methodsmentioning

confidence: 99%

“…These variables include animal species, perfusion temperature, pump perfusion versus gravity-feed perfusion, perfusion with or without submerging the heart in perfusate, single-mode or multimode operating apparatuses, consisting of one pump or two pumps, and varying perfusates. 5–13 In addition, perfusion may take place either with an empty-beating heart where the left atrial (LA) pressure is maintained at 0 mm Hg (Langendorff, nonworking mode [NWM] perfusion) or with more physiologically relevant LA pressures where, in each cardiac cycle, the left heart is getting filled and ejecting the perfusate (working mode [WM] perfusion).…”

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confidence: 99%

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The Position of the Heart During Normothermic Ex Situ Heart Perfusion is an Important Factor in Preservation and Recovery of Myocardial Function

et al. 2021

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Section: Methodsmentioning

confidence: 99%

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confidence: 99%

The Position of the Heart During Normothermic Ex Situ Heart Perfusion is an Important Factor in Preservation and Recovery of Myocardial Function

et al. 2021

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“…1 These donors typically include older individuals, those with previous conditions, and donors with circulatory (DCD), as opposed to brain (DBD), determined death. 2,3 The potential risks of using extended criteria hearts have motivated the study of non-beating, 4,5 empty beating, 6 and working heart models [7][8][9][10] to perfuse the cardiac muscles and provide indicators of heart performance prior to transplantation.…”

Section: Introductionmentioning

confidence: 99%

“…As an alternative to Windkessel-based afterloads, some groups have pumped perfusate retrograde into the aorta with a centrifugal pump to control diastolic aortic pressure. 10,13,20 These systems ensure diastolic aortic pressure regardless of cardiac output. However, systolic pressure is left uncontrolled and dependent on the geometry and position of the perfusate path and the rotational-velocitydependent flow impedance of the centrifugal pump.…”

Section: Introductionmentioning

confidence: 99%

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A novel nonlinear afterload for ex vivo heart evaluation: Porcine experimental results

et al. 2022

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Background Existing working heart models for ex vivo functional evaluation of donor hearts often use cardiac afterloads made up of discrete resistive and compliant elements. This approach limits the practicality of independently controlling systolic and diastolic aortic pressure to safely test the heart under multiple loading conditions. We present and investigate a novel afterload concept designed to enable such control. Methods Six ∼70 kg pig hearts were evaluated in vivo, then ex vivo in left‐ventricular working mode using the presented afterload. Both in vivo and ex vivo, the hearts were evaluated at two exertion levels: at rest and following a 20 μg adrenaline bolus, while measuring aortic pressure and flow, left ventricular pressure and volume, and left atrial pressure. Results The afterload gave aortic pressure waveforms that matched the general shape of the in vivo measurements. A wide range of physiological systolic pressures (93 to 160 mm Hg) and diastolic pressures (73 to 113 mm Hg) were generated by the afterload. Conclusions With the presented afterload concept, multiple physiological loading conditions could be tested ex vivo, and compared with the corresponding in vivo data. An additional control loop from the set pressure limits to the measured systolic and diastolic aortic pressure is proposed to address discrepancies observed between the set limits and the measured pressures.

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A Multi-Mode System for Myocardial Functional and Physiological Assessment during Ex Situ Heart Perfusion

Duignan,

Guariento,

Doulamis

et al. 2020

J Extra Corpor Technol

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Ex situ heart perfusion (ESHP) has proven to be an important and valuable step toward better preservation of donor hearts for heart transplantation. Currently, few ESHP systems allow for a convenient functional and physiological evaluation of the heart. We sought to establish a simple system that provides functional and physiological assessment of the heart during ESHP. The ESHP circuit consists of an oxygenator, a heart–lung machine, a heater–cooler unit, an anesthesia gas blender, and a collection funnel. Female Yorkshire pig hearts (n = 10) had del Nido cardioplegia (4°C) administered, excised, and attached to the perfusion system. Hearts were perfused retrogradely into the aortic root for 2 hours before converting the system to an isovolumic mode or a working mode for further 2 hours. Blood samples were analyzed to measure metabolic parameters. During the isovolumic mode (n = 5), a balloon inserted in the left ventricular (LV) cavity was inflated so that an end-diastolic pressure of 6–8 mmHg was reached. During the working mode (n = 5), perfusion in the aortic root was redirected into left atrium (LA) using a compliance chamber which maintained an LA pressure of 6–8 mmHg. Another compliance chamber was used to provide an afterload of 40–50 mmHg. Hemodynamic and metabolic conditions remained stable and consistent for a period of 4 hours of ESHP in both isovolumic mode (LV developed pressure: 101.0 ± 3.5 vs. 99.7 ± 6.8 mmHg, p = .979, at 2 and 4 hours, respectively) and working mode (LV developed pressure: 91.0 ± 2.6 vs. 90.7 ± 2.5 mmHg, p = .942, at 2 and 4 hours, respectively). The present study proposed a novel ESHP system that enables comprehensive functional and metabolic assessment of large mammalian hearts. This system allowed for stable myocardial function for up to 4 hours of perfusion, which would offer great potential for the development of translational therapeutic protocols to improve dysfunctional donated hearts.

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Normothermic Ex Situ Heart Perfusion in Working Mode: Assessment of Cardiac Function and Metabolism

Cited by 6 publications

References 0 publications

The Position of the Heart During Normothermic Ex Situ Heart Perfusion is an Important Factor in Preservation and Recovery of Myocardial Function

The Position of the Heart During Normothermic Ex Situ Heart Perfusion is an Important Factor in Preservation and Recovery of Myocardial Function

A novel nonlinear afterload for ex vivo heart evaluation: Porcine experimental results

A Multi-Mode System for Myocardial Functional and Physiological Assessment during Ex Situ Heart Perfusion

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