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- Title
A Multi-Mode System for Myocardial Functional and Physiological Assessment during Ex Situ Heart Perfusion.
- Authors
Duignan, Thomas; Guariento, Alvise; Doulamis, Ilias P.; Takashi Kido; Regan, William L.; Saeed, Mossab; Hoganson, David M.; Emani, Sitaram M.; del Nido, Pedro J.; McCully, James D.; Matte, Gregory S.
- Abstract
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 6 3.5 vs. 99.7 6 6.8 mmHg, p 5 .979, at 2 and 4 hours, respectively) and working mode (LV developed pressure: 91.0 6 2.6 vs. 90.7 6 2.5 mmHg, p 5 .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.
- Subjects
HEART function tests; YORKSHIRE swine; LEFT heart atrium; MECHANICAL hearts; PERFUSION
- Publication
Journal of Extra-Corporeal Technology, 2020, Vol 52, Issue 4, p303
- ISSN
0022-1058
- Publication type
Article
- DOI
10.1051/ject/202052303