Posttransplant function of a nonbeating heart is predictable by an ex vivo perfusion method

Suehiro, Kotaro; Mohri, Makoto; Yamaguchi, Hiroki; Takagaki, Masami; Hisamochi, Kunikazu; Morimoto, T; Sano, Shunji

doi:10.1016/s0003-4975(00)01939-1

Cited by 28 publications

(28 citation statements)

References 12 publications

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“…1 Ex vivo assessments of myocardial function require the presence of an oxygen carrier to meet the metabolic demands of a normothermic working heart. Previous studies have used whole blood, [15][16][17][18][19] red blood cell, 20 and HBOC 5,21 based solutions for this purpose; however, whether the type of oxygen carrier affects the preservation of myocardial function during EVHP is unknown. We have now shown that a whole blood-based perfusate minimizes injury and provides superior preservation of myocardial function during EVHP.…”

Section: Discussionmentioning

confidence: 99%

A whole blood–based perfusate provides superior preservation of myocardial function during ex vivo heart perfusion

White¹,

Hasanally²,

Mundt³

et al. 2015

The Journal of Heart and Lung Transplantation

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Section: Discussionmentioning

confidence: 99%

A whole blood–based perfusate provides superior preservation of myocardial function during ex vivo heart perfusion

White¹,

Hasanally²,

Mundt³

et al. 2015

The Journal of Heart and Lung Transplantation

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“…4). Inconsistent recovery of hearts procured from the NHBD is a problem that has also been described with other MP techniques [45,[51][52][53][54].…”

Section: Use Of Mp To Expand the Donor Poolmentioning

confidence: 99%

“…Clinical markers of myocardial damage such as troponin I and CK MB are dependent on reperfusion injury as much as the initial ischemic insult and as a result are of limited value when assessed during hypothermic MP with crystalloid perfusate prior to whole blood reperfusion [56,57]. Suehiro et al [53] assessed viability of hearts exposed to 60 min of global warm ischemia using an ex vivo perfusion apparatus in which hearts were perfused with autologous whole blood for a short interval after cardiectomy followed by CS for the duration of the ex vivo period. Hearts that were able to eject against 80 mmHg afterload showed good function after orthotopic heart transplant, whereas those with poor ex vivo performance were unable to be weaned from inotropes.…”

Section: Use Of Mp To Expand the Donor Poolmentioning

confidence: 99%

Preserving and evaluating hearts with ex vivo machine perfusion: an avenue to improve early graft performance and expand the donor pool☆

Collins

Moainie

Griffith

et al. 2008

European Journal of Cardio-Thoracic Surgery

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Cardiac transplantation remains the first choice for the surgical treatment of end stage heart failure. An inadequate supply of donor grafts that meet existing criteria has limited the application of this therapy to suitable candidates and increased interest in extended criteria donors. Although cold storage (CS) is a time-tested method for the preservation of hearts during the ex vivo transport interval, its disadvantages are highlighted in hearts from the extended criteria donor. In contrast, transport of high-risk hearts using hypothermic machine perfusion (MP) provides continuous support of aerobic metabolism and ongoing washout of metabolic byproducts. Perhaps more importantly, monitoring the organ's response to this intervention provides insight into the viability of a heart initially deemed as extended criteria. Obviously, ex vivo MP introduces challenges, such as ensuring homogeneous tissue perfusion and avoiding myocardial edema. Though numerous groups have experimented with this technology, the best perfusate and perfusion parameters needed to achieve optimal results remain unclear. In the present review, we outline the benefits of ex vivo MP with particular attention to how the challenges can be addressed in order to achieve the most consistent results in a large animal model of the ideal heart donor. We provide evidence that MP can be used to resuscitate and evaluate hearts from animal and human extended criteria donors, including the non-heart beating donor, which we feel is the most compelling argument for why this technology is likely to impact the donor pool.

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“…2) Nevertheless, cardiac transplantation with NHBD allografts has not proceeded beyond the laboratory because irreversible damage to myocardial tissue occurs after 20 minutes of normothermic ischemia 3) and hearts in NHBDs undergo prolonged normothermic ischemia during cardiac arrest and severe ischemia/reperfusion (I/R) injury following prolonged warm ischemia. 4) Scheule, et al insisted that reperfusion injury is a vital problem in NHBD organs. 1) Therefore, effective methods for protecting the graft against ischemic injury are required to establish cardiac transplantation with NHBDs.…”

mentioning

confidence: 99%

The Suppression of Proinflammatory Cytokines Improves Heart Function From Non-Heart-Beating Donors Following Transplantation in a Canine Model

et al. 2009

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SummaryWe evaluated the effectiveness of a suppressant of the production of proinflammatory cytokines such as interleukin (IL)-1 and tumor necrosis factor (TNF)-α on a canine heart transplantation model with non-heart-beating donors (NHBDs).Adult mongrel dogs were divided into 3 groups of 5: a control group; FR-1 in which donors were given FR167653, a potent suppressant of IL-1 β and TNF-α production; and FR-2 in which both donors and recipients were given FR167653. After measuring the baseline hemodynamic parameters, including cardiac output (CO), left ventricular pressure (LVP), and maximum and minimum rates of increase in LVP (± LVdp/dt), FR167653 was administered continuously for 30 minutes before ischemia in the FR-1 and FR-2 groups. Cardiac arrest was obtained by rapid exsanguination from the abdominal aorta and inferior vena cava. The organ was left in the cadaver for 30 minutes. The coronary vascular beds were washed out with 4°C Celsior solution, and then the donor heart was preserved in 4°C Celsior solution for 4 hours. The donor heart was transplanted orthotopically with cardiopulmonary bypass (CPB). FR167653 was administered intravenously from 15 minutes before aortic-cross clamping until the end of the experiment in the FR-2 group. The recipient was weaned from CPB 1 hour after reperfusion. We compared the hemodynamic parameters at 3 hours after reperfusion with the preoperative values in donor animals with the right atrial pressure at 10 mmHg and a 5 μg/kg/min dopamine infusion. Histopathological analysis was also performed.There were no significant differences in the recovery rates of the hemodynamic parameters between the control and FR-1 groups and between the FR-1 and FR-2 groups. However, the recovery rates of CO and -LVdp/dt in the FR-2 group were significantly (P < 0.05) higher than those in the control group. Histopathological analysis showed that myofilaments were better preserved in the FR-2 group compared with the control group.The administration of a suppressant of proinflammatory cytokines before both ischemia and reperfusion effectively preserves donor heart function after transplantation with NHBDs. (Int Heart J 2009; 50: 235-245) From the

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Posttransplant function of a nonbeating heart is predictable by an ex vivo perfusion method

Cited by 28 publications

References 12 publications

A whole blood–based perfusate provides superior preservation of myocardial function during ex vivo heart perfusion

A whole blood–based perfusate provides superior preservation of myocardial function during ex vivo heart perfusion

Preserving and evaluating hearts with ex vivo machine perfusion: an avenue to improve early graft performance and expand the donor pool☆

The Suppression of Proinflammatory Cytokines Improves Heart Function From Non-Heart-Beating Donors Following Transplantation in a Canine Model

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