The Position of the Heart During Normothermic Ex Situ Heart Perfusion is an Important Factor in Preservation and Recovery of Myocardial Function.
Journal
ASAIO journal (American Society for Artificial Internal Organs : 1992)
ISSN: 1538-943X
Titre abrégé: ASAIO J
Pays: United States
ID NLM: 9204109
Informations de publication
Date de publication:
01 11 2021
01 11 2021
Historique:
pubmed:
21
3
2021
medline:
15
12
2021
entrez:
20
3
2021
Statut:
ppublish
Résumé
Ex situ heart perfusion (ESHP) is being investigated as a method for the continuous preservation of the myocardium in a semiphysiologic state for subsequent transplantation. Most methods of ESHP position the isolated heart in a hanging (H) state, representing a considerable departure from the in vivo anatomical positioning of the heart and may negatively affect the functional preservation of the heart. In the current study, cardiac functional and metabolic parameters were assessed in healthy pig hearts, perfused for 12 hours, in either an H, or supported (S) position, either in nonworking mode (NWM) or working mode (WM). The cardiac function was best preserved in the S position hearts in WM (median 11 hour cardiac index (CI)/1 hour CI%: working mode perfusion in supported position = 94.77% versus nonworking mode perfusion in supported position = 62.80%, working mode perfusion in H position = 36.18%, nonworking mode perfusion in H position = 9.75%; p < 0.001). Delivery of pyruvate bolus significantly improved the function in S groups, however, only partially reversed myocardial dysfunction in the H heart groups. The hearts perfused ex situ in a semianatomical S position and in physiologic WM had better functional preservation and recovery than the H hearts in non-S position. Optimizing the positional support for the ex situ-perfused hearts may improve myocardial preservation during ESHP.
Identifiants
pubmed: 33741785
doi: 10.1097/MAT.0000000000001386
pii: 00002480-202111000-00007
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1222-1231Subventions
Organisme : CIHR
Pays : Canada
Informations de copyright
Copyright © ASAIO 2021.
Références
Ardehali A, Esmailian F, Deng M, et al.; PROCEED II Trial Investigators: Ex-vivo perfusion of donor hearts for human heart transplantation (PROCEED II): A prospective, open-label, multicentre, randomised non-inferiority trial. Lancet. 385: 2577–2584, 2015.
Hatami S, Freed DH: Machine perfusion of donor heart: State of the art. Curr Transpl Rep. 6: 242–250, 2019.
Hatami S, White CW, Shan S, et al.: Myocardial functional decline during prolonged ex situ heart perfusion. Ann Thorac Surg. 108: 499–507, 2019.
Sandha JK, White CW, Müller A, et al.: Steroids limit myocardial edema during ex vivo perfusion of hearts donated after circulatory death. Ann Thorac Surg. 105: 1763–1770, 2018.
Church JT, Alghanem F, Deatrick KB, et al.: Normothermic ex vivo heart perfusion: Effects of live animal blood and plasma cross circulation. ASAIO J. 63: 766–773, 2017.
Garbade J, Krautz C, Aupperle H, et al.: Functional, metabolic, and morphological aspects of continuous, normothermic heart preservation: Effects of different preparation and perfusion techniques. Tissue Eng Part C Methods. 15: 275–283, 2009.
Hatami S, White CW, Ondrus M, et al.: Normothermic ex situ heart perfusion in working mode: Assessment of cardiac function and metabolism. J Vis Exp. 2019. doi: 10.3791/58430.
doi: 10.3791/58430
Ozeki T, Kwon MH, Gu J, et al.: Heart preservation using continuous ex vivo perfusion improves viability and functional recovery. Circ J. 71: 153–159, 2007.
Schraufnagel DP, Steffen RJ, Vargo PR, et al.: Devices for ex vivo heart and lung perfusion. Expert Rev Med Devices. 15: 183–191, 2018.
Tolboom H, Olejnickova V, Reser D, et al.: Moderate hypothermia during ex vivo machine perfusion promotes recovery of hearts donated after cardiocirculatory deathdagger. Eur J Cardiothorac Surg. 49:25–31, 2016.
Trahanas JM, Witer LJ, Alghanem F, et al.: Achieving 12 hour normothermic ex situ heart perfusion: An experience of 40 porcine hearts. ASAIO J. 62:470–476, 2016.
Van Caenegem O, Beauloye C, Bertrand L, et al.: Hypothermic continuous machine perfusion enables preservation of energy charge and functional recovery of heart grafts in an ex vivo model of donation following circulatory death. Eur J Cardiothorac Surg. 49: 1348–1353, 2016.
Xin L, Gellner B, Ribeiro RVP, et al.: A new multi-mode perfusion system for ex vivo heart perfusion study. J Med Syst. 42: 25, 2017.
Cobert ML, Peltz M, West LM, Merritt ME, Jessen ME: Glucose is an ineffective substrate for preservation of machine perfused donor hearts. J Surg Res. 173: 198–205, 2012.
Iyer A, Gao L, Doyle A, et al.: Increasing the tolerance of DCD hearts to warm ischemia by pharmacological postconditioning. Am J Transplant. 14: 1744–1752, 2014.
White CW, Hasanally D, Mundt P, et al.: A wholeblood–based perfusate provides superior preservation of myocardial function during ex vivo heart perfusion. J Heart Lung Transplant. S1053-2498:01356-01354, 2014.
Rehman I, Rehman A: Anatomy, Thorax, Pericardium. Treasure Island, FL, StatPearls Publishing StatPearls Publishing LLC, 2019.
Messer S, Ardehali A, Tsui S: Normothermic donor heart perfusion: Current clinical experience and the future. Transpl Int. 28: 634–642, 2015.
Robinson TF, Factor SM, Sonnenblick EH: The heart as a suction pump. Sci Am. 254: 84–91, 1986.
Hinghofer-Szalkay H: Gravity, the hydrostatic indifference concept and the cardiovascular system. Eur J Appl Physiol. 111: 163–174, 2011.
Malanga CJ: Structure and function of the heart. in Enna SJ, Bylund DB (eds), XPharm: The Comprehensive Pharmacology Reference. United Kingdom: Elsevier, 2007, pp. 1–5.
Hickman PE, Potter JM, Aroney C, et al.: Cardiac troponin may be released by ischemia alone, without necrosis. Clin Chim Acta. 411: 318–323, 2010.
Tanindi A, Cemri M: Troponin elevation in conditions other than acute coronary syndromes. Vasc Health Risk Manag. 7: 597–603, 2011.
Hatami S, White CW, Qi X, et al.: Immunity and stress responses are induced during ex situ heart perfusion. Circ Heart Fail. 13: e006552, 2020.
Stamp NL, Shah A, Vincent V, et al.: Successful heart transplant after ten hours out-of-body time using the transmedics organ care system. Heart Lung Circ. 24: 611–613, 2015.
White CW, Ambrose E, Müller A, et al.: Assessment of donor heart viability during ex vivo heart perfusion. Can J Physiol Pharmacol. 93: 893–901, 2015.
White CW, Ali A, Hasanally D, et al.: A cardioprotective preservation strategy employing ex vivo heart perfusion facilitates successful transplant of donor hearts after cardiocirculatory death. J Heart Lung Transplant. 32: 734–743, 2013.
Hill AJ, Iaizzo PA: Comparative cardiac anatomy. Iaizzo PA (ed), in: Handbook of Cardiac Anatomy, Physiology, and Devices. Totowa, NJ, Humana Press, 2005, pp. 81–91.