Perfusion Preservation of the Donor Heart: Basic Science to Pre-Clinical

Rivard, Andrew L.; Gallegos, Robert P.; Ogden, Irene M.; Bianco, Richard W.

doi:10.1051/ject/200941140

Cited by 14 publications

(2 citation statements)

References 51 publications

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“…Additionally, the low perfusion pressures (<20 mmHg) minimized hydrostatic edema development to less than 8%. While the extent of the edema may not be the only factor in determining the suitability for transplantation, severe edema can impact the success of organ transplantation ( 28 ). One of the advantages of the VP.S ENCORE® device is no need for blood or blood-based products to be used.…”

Section: Discussionmentioning

confidence: 99%

Novel portable hypothermic machine perfusion preservation device enhances cardiac viability of donated human hearts

Andrijauskaite,

Veraza,

Lopez

et al. 2024

Front. Cardiovasc. Med.

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IntroductionHeart transplant remains the gold standard treatment for patients with advanced heart failure. However, the list of patients waiting for a heart transplant continues to increase. We have developed a portable hypothermic oxygenated machine perfusion device, the VP.S ENCORE®, to extend the allowable preservation time. The purpose of this study was to test the efficacy of the VP.S. ENCORE® using deceased donors derived hearts.MethodsHearts from brain-dead donors not utilized for transplant (n = 11) were offered for research from the Texas Organ Sharing Alliance (TOSA), South and Central Texas' Organ Procurement Organization (OPO) and were preserved in the VP.S ENCORE® for 4 (n = 2), 6 (n = 3), and 8 (n = 3) hours or were kept in static cold storage (SCS) (n = 3). After preservation, the hearts were placed in an isolated heart Langendorff model for reperfusion and evaluated for cardiac function.ResultsThe mean donor age was 37.82 ± 12.67 with the youngest donor being 19 and the oldest donor being 58 years old. SCS hearts mean weight gain (%) was −1.4 ± 2.77, while perfused at 4 h was 5.6 ± 6.04, perfused at 6 h 2.1 ± 6.04, and 8 h was 7.2 ± 10.76. Venous and arterial lactate concentrations were less than 2.0 mmol/L across all perfused hearts. Left ventricular contractility (+dPdT, mmHg/s) for 4 h (1,214 ± 1,064), 6 (1,565 ± 141.3), and 8 h (1,331 ± 403.6) were within the range of healthy human heart function. Thus, not significant as compared to the SCS group (1,597 ± 342.2). However, the left ventricular relaxation (mmHg/s) was significant in 6-hour perfused heart (p < 0.05) as compared to SCS. Gene expression analysis of inflammation markers (IL-6, IL-1β) showed no significant differences between SCS and perfused hearts, but a 6-hour perfusion led to a downregulated expression of these markers.DiscussionThe results demonstrate that the VP.S ENCORE® device enhances cardiac viability and exhibits comparable cardiac function to a healthy heart. The implications of these findings suggest that the VP.S ENCORE® could introduce a new paradigm in the field of organ preservation, especially for marginal hearts.

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Section: Discussionmentioning

confidence: 99%

Novel portable hypothermic machine perfusion preservation device enhances cardiac viability of donated human hearts

Andrijauskaite,

Veraza,

Lopez

et al. 2024

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

show abstract

“…For example, relative to other solid organs, the high metabolic rate of the heart increases the rate of ATP depletion and thus myocardial necrosis. 63,64 Intracellular edema occurs as a result of energy depletion, in addition to poor subendocardial lymphatic drainage during each contraction. 65…”

Section: Heart Hemodynamicsmentioning

confidence: 99%

The Use of Hemoglobin-Based Oxygen Carriers in Ex Vivo Machine Perfusion of Donor Organs for Transplantation

et al. 2022

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There has been significant progress in the development of ex vivo machine perfusion for the nonischemic preservation of donor organs. However, several complications remain, including the logistics of using human blood for graft oxygenation and hemolysis occurring as a result of mechanical technology. Recently, hemoglobin-based oxygen carriers, originally developed for use as blood substitutes, have been studied as an alternative to red blood cell–based perfusates. Although research in this field is somewhat limited, the findings are promising. We offer a brief review of the use of hemoglobin-based oxygen carriers in ex vivo machine perfusion and discuss future directions that will likely have a major impact in progressing oxygen carrier use in clinical practice.

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Development of a human heart‐sized perfusion system for metabolic imaging studies using hyperpolarized [1‐¹³C]pyruvate MRI

Mariager

Hansen

Bech

et al. 2020

Magnetic Resonance in Med

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Purpose Increasing worldwide demand for cardiac transplantation has spurred new developments to increase the donor pool. Normothermic preservation of heart grafts for transplantation is an emerging strategy to improve the utilization of marginal grafts. Hyperpolarized MR using metabolic tracers such as [1‐13C]pyruvate, provide a novel means of investigating metabolic status without the use of ionizing radiation. We demonstrate the use of this methodology to examine ex vivo perfused porcine heart grafts. Methods Hearts from three 40‐kg Danish domestic pigs were harvested and subsequently perfused in Langendorff mode under normothermic conditions, using an MR‐compatible perfusion system adapted to the heart. Proton MRI and hyperpolarized [1‐13C]pyruvate were used to investigate and quantify the functional and metabolic status of the grafts. Results Hearts were perfused with whole blood for 120 min, using a dynamic contrast‐enhanced perfusion experiment to verify successful myocardial perfusion. Hyperpolarized [1‐13C]pyruvate MRI was used to assess the metabolic state of the myocardium. Functional assessment was performed using CINE imaging and ventricular pressure data. High lactate and modest alanine levels were observed in the hyperpolarized experiment. The functional assessment produced reduced functional parameters. This suggests an altered functional and metabolic profile compared with corresponding in vivo values. Conclusion We investigated the metabolic and functional status of machine‐perfused porcine hearts. Utilizing hyperpolarized methodology to acquire detailed myocardial metabolic information—in combination with already established MR methods for cardiac investigation—provides a powerful tool to aid the progress of donor heart preservation.

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Perfusion Preservation of the Donor Heart: Basic Science to Pre-Clinical

Cited by 14 publications

References 51 publications

Novel portable hypothermic machine perfusion preservation device enhances cardiac viability of donated human hearts

Novel portable hypothermic machine perfusion preservation device enhances cardiac viability of donated human hearts

The Use of Hemoglobin-Based Oxygen Carriers in Ex Vivo Machine Perfusion of Donor Organs for Transplantation

Development of a human heart‐sized perfusion system for metabolic imaging studies using hyperpolarized [1‐¹³C]pyruvate MRI

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Perfusion Preservation of the Donor Heart: Basic Science to Pre-Clinical

Cited by 14 publications

References 51 publications

Novel portable hypothermic machine perfusion preservation device enhances cardiac viability of donated human hearts

Novel portable hypothermic machine perfusion preservation device enhances cardiac viability of donated human hearts

The Use of Hemoglobin-Based Oxygen Carriers in Ex Vivo Machine Perfusion of Donor Organs for Transplantation

Development of a human heart‐sized perfusion system for metabolic imaging studies using hyperpolarized [1‐13C]pyruvate MRI

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Development of a human heart‐sized perfusion system for metabolic imaging studies using hyperpolarized [1‐¹³C]pyruvate MRI