Faculty Collaboration Database

Functional evaluation of human donation after cardiac death donor hearts using a continuous isolated myocardial perfusion technique: Potential for expansion of the cardiac donor population. J Thorac Cardiovasc Surg 2014 Sep;148(3):1123-30; discussion 1130

Date

08/19/2014

Pubmed ID

25129607

DOI

10.1016/j.jtcvs.2014.06.050

Scopus ID

2-s2.0-84908530417 (requires institutional sign-in at Scopus site)   16 Citations

Abstract

OBJECTIVE: To investigate the resuscitation potential and contractile function in adult human donation after cardiac death (DCD) hearts by ex vivo perfusion.

METHODS: With institutional review board approval and under the DCD protocol at the University of Wisconsin (UW) Organ Procurement Organization, 5 brain dead (BD) and 5 DCD donor hearts were evaluated. All BD hearts were declined for clinical transplantation because of coronary artery disease, advanced age, or social history. All hearts were preserved by flushing and cold storage with UW solution. By using our ex vivo perfusion system, the left ventricular end systolic pressure-volume relationship (LV-ESPVR) was assessed for 2 hours of oxygenated blood reperfusion.

RESULTS: All BD (n = 5) and 4 DCD hearts were successfully resuscitated. One DCD heart was unable to be resuscitated due to prolonged warm ischemic time (WIT; 174 minutes). Mean WIT for resuscitated DCD hearts (from extubation to flushing with cold UW solution) was 34 ± 3 minutes (range, 26 to 40 minutes); mean cold ischemic time for BD donors was 211 ± 31 minutes compared with 177 ± 64 minutes for DCD donors. The calculated LV-ESPVRs for BD hearts after 1 and 2 hours of reperfusion were 6.9 ± 0.7 and 5.7 ± 1.0 mm Hg/mL, respectively; LV-ESPVRs for DCD hearts after 1 and 2 hours of reperfusion were 5.6 ± 1.5 (P = .45) and 3.0 ± 0.7 mm Hg/mL (P = .07), respectively.

CONCLUSIONS: We successfully resuscitated and measured ex vivo cardiac function in human DCD and BD donor hearts. Resuscitation potential in DCD hearts was achieved when the WIT was less than 40 minutes. Contractile performance in DCD hearts tended to be lower compared with BD hearts. Further investigation with longer reperfusion periods seems warranted.

Author List

Osaki S, Locher MR, Lushaj EB, Akhter SA, Kohmoto T

Author

Takushi Kohmoto MD, PhD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adenosine
Adult
Allopurinol
Brain Death
Cold Ischemia
Female
Glutathione
Heart Diseases
Heart Transplantation
Humans
Insulin
Male
Middle Aged
Myocardial Contraction
Organ Preservation Solutions
Perfusion
Raffinose
Time Factors
Tissue Donors
Tissue and Organ Harvesting
Ventricular Function, Left
Ventricular Pressure
Warm Ischemia
Wisconsin