Studies of the effects of hypothermia on regional myocardial blood flow and metabolism during cardiopulmonary bypass

Gd, Buckberg; Brazier,; Rl, Nelson; Sm, Goldstein; Dh, McConnell; Cooper, Norman

doi:10.1016/s0022-5223(19)39985-4

Cited by 353 publications

(68 citation statements)

References 21 publications

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“…Although universally adopted, cold ischaemic storage is known to be imperfect as low levels of anaerobic metabolism continue in the background with the subsequent depletion of adenosine triphosphate (ATP) stores and increase in acidosis . Attempts at continuous machine perfusion using hypothermic preservation solutions have been made and found to provide superior systolic function with preserved ATP levels compared with cold storage .…”

Section: Introductionmentioning

confidence: 99%

Normothermic donor heart perfusion: current clinical experience and the future

2014

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Following the first successful heart transplant in 1967, more than 100 000 heart transplants have been carried out worldwide. These procedures have mostly relied on cold ischaemic preservation of the donor heart because this simple technique is inexpensive and relatively reliable. However, the well-known limitations of cold ischaemic preservation imposes significant logistical challenges to heart transplantation which put a ceiling on the immediate success on this life-saving therapy, and limits the number of donor hearts that can be safely transplanted annually. Although the theoretical advantages of normothermic donor heart perfusion have been recognised for over a century, the technology to transport donor hearts in this state has only been developed within the last decade. The Organ Care System (OCS) which is designed and manufactured by TransMedics Inc. is currently the only commercially available device with this capability. This article reviews the history of normothermic heart perfusion and the clinical experience with the TransMedics OCS to date. We have also attempted to speculate on the future possibilities of this innovative and exciting technology.

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Section: Introductionmentioning

confidence: 99%

Normothermic donor heart perfusion: current clinical experience and the future

2014

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“…Since Gibbon introduced a heart‐lung machine in cardiac surgery, several issues on myocardial protection have been raised and overcome . Induced hypothermia, ventricular fibrillation, blood or crystalloid cardioplegia, and antegrade and retrograde infusion methods have been introduced and utilized in appropriate circumstances for the intended surgical procedures.…”

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confidence: 99%

Myocardial Protective Effect of Antegrade Cardioplegic Cardiac Arrest Versus Ventricular Fibrillation During Cardiopulmonary Bypass on Immediate Postoperative and Mid‐Term Left Ventricular Function in Right Ventricular Outflow Tract Surgery

et al. 2017

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The objective of this study is to examine the myocardial protective effect of antegrade cardioplegic cardiac arrest (ACC) versus ventricular fibrillation (VF) on short-term and mid-term left ventricular (LV) function in right ventricular outflow tract (RVOT) surgery. RVOT operations conducted from January 2006 to December 2015 were reviewed. The numbers of cases using ACC and VF were 71 and 49, respectively. Postoperative mortality and morbidity were compared between the two groups. Before and after propensity score matching, left ventricular ejection fraction (LVEF) and left ventricular end-systolic/end-diastolic diameter (LVESD/LVEDD) in echocardiography were measured immediately after operation and at mid-term follow-up between postoperative 6 and 24 months. There was no perioperative mortality or cerebrovascular accident. There was no statistically significant difference in the incidence of ventricular and atrial arrhythmia. In the overall patient group, LVESD was significantly decreased in the ACC group compared to the VF group immediately after operation (-0.65 ± 3.55 mm vs. 2.99 ± 4.98 mm, P = 0.001). Mid-term follow-up data demonstrated that LVEF at midterm was higher in the ACC group than in the VF group (64.80% ± 7.40% vs. 60.24% ± 7.93%, P = 0.022). However, the increased amount compared to preoperative value was not statistically significant (1.94% ± 12.65% vs. -2.94% ± 9.41%, P = 0.059). After propensity score matching, the LVEF was significantly improved in the ACC group compared to the VF group at the mid-term follow-up (6.16% ± 6.77% vs. -5.41% ± 9.05%, P = 0.001). Multiple linear regression model demonstrated that lower preoperative LVEF, ACC rather than VF, and exclusion of RVOT reconstruction procedure were positive prognostic factors for the improvement of LVEF at mid-term follow up. The results of this study suggest that myocardial protection using ACC is safe and may be more beneficial in LV function recovery up to the mid-term follow-up after pulmonary valve replacement and other RVOT procedures.

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“…It has been observed that the empty beating, normothermic heart requires 75–90% less oxygen than does the normal working heart. A further reduction in temperature to 22 °C results in a 70% decrease in oxygen demand, which equates to 0.3 ml/min per 100 g of myocardium [22]. In view of the above findings, we opted to use a 26 °C temperature perfusate in our experiment, which equates to a 90% decrease in oxygen demand of myocardium compared with the normothermic empty beating heart.…”

Section: Discussionmentioning

confidence: 99%

Continuous perfusion of donor hearts with oxygenated blood cardioplegia improves graft function

Zhang

Wen

et al. 2010

Transplant International

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Summary Donor hearts cannot be preserved beyond 6 h using cold storage (CS). Improving preservation methods may permit prolonged storage of donor heart. We compared graft function in large animal model after prolonged preservation (8 h) using continuous perfusion (CP) and CS method. Twenty‐four miniature pigs were used as donors and recipients. Donor hearts were either stored in University of Wisconsin solution (UW solution) for 8 h at 0–4 °C (CS group, n = 6) or were continuously perfused with oxygenated blood cardioplegia at 26 °C for 8 h (CP group, n = 6). After preservation, hearts were transplanted into recipients and reperfused for 3 h. Left ventricular (LV) function, cardiac output (CO), malondialdehyde (MDA) and adenosine triphosphate (ATP) levels, and water content were measured. Although water content of CP hearts was higher than that of CS, LV contractility and diastolic function of CP hearts were superior to those of CS. In addition, CP hearts performed better than CS hearts on CO in working heart state. ATP was better preserved and MDA levels were lower in CP hearts compared with those of CS (P < 0.0001). Donor hearts can be preserved longer using continuous perfusion with oxygenated blood cardioplegia and this method prevents time‐dependent ischemic injury.

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Studies of the effects of hypothermia on regional myocardial blood flow and metabolism during cardiopulmonary bypass

Cited by 353 publications

References 21 publications

Normothermic donor heart perfusion: current clinical experience and the future

Normothermic donor heart perfusion: current clinical experience and the future

Myocardial Protective Effect of Antegrade Cardioplegic Cardiac Arrest Versus Ventricular Fibrillation During Cardiopulmonary Bypass on Immediate Postoperative and Mid‐Term Left Ventricular Function in Right Ventricular Outflow Tract Surgery

Continuous perfusion of donor hearts with oxygenated blood cardioplegia improves graft function

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