Resuscitation of Non-Beating Donor Hearts Using Continuous Myocardial Perfusion: The Importance of Controlled Initial Reperfusion

Osaki, Satoru; Ishino, Kozo; Kotani, Yasuhiro; Honjo, Osami; Suezawa, Takanori; Kanki, Kazushige; Sano, Shunji

doi:10.1016/j.athoracsur.2006.01.066

Cited by 49 publications

(55 citation statements)

References 18 publications

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“…Previous studies of myocardial recovery in large animal DCD models have exposed the heart to WITs ranging from 15 to 30 min, with varying results (2,3,26). Ali et al (3) in a porcine model demonstrated good biventricular functional recovery postorthotopic transplantation following 20.9 AE 2.8-min WIT, while Osaki et al (26) reported partial recovery of hearts subjected to 30-min WIT in a porcine transplant model using controlled initial reperfusion.…”

Section: Discussionmentioning

confidence: 99%

“…Ali et al (3) in a porcine model demonstrated good biventricular functional recovery postorthotopic transplantation following 20.9 AE 2.8-min WIT, while Osaki et al (26) reported partial recovery of hearts subjected to 30-min WIT in a porcine transplant model using controlled initial reperfusion. Similarly, Repse et al (2) also showed inferior cardiac power recovery of canine hearts subjected to 30-min WIT compared with normal control hearts.…”

Section: Discussionmentioning

confidence: 99%

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Increasing the Tolerance of DCD Hearts to Warm Ischemia by Pharmacological Postconditioning

Iyer

Gao

Doyle

et al. 2014

American Journal of Transplantation

116

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Donation after circulatory death (DCD) offers a potential additional source of cardiac allografts. We used a porcine asphyxia model to evaluate viability of DCD hearts subjected to warm ischemic times (WIT) of 20-40 min prior to flushing with Celsior (C) solution. We then assessed potential benefits of supplementing C with erythropoietin, glyceryl trinitrate and zoniporide (Cs), a combination that we have shown previously to activate ischemic postconditioning pathways. Hearts flushed with C/Cs were assessed for functional, biochemical and metabolic recovery on an ex vivo working heart apparatus. Hearts exposed to 20-min WIT showed full recovery of functional and metabolic profiles compared with control hearts (no WIT). Hearts subjected to 30-or 40-min WIT prior to C solution showed partial and no recovery, respectively. Hearts exposed to 30-min WIT and Cs solution displayed complete recovery, while hearts exposed to 40-min WIT and Cs solution demonstrated partial recovery. We conclude that DCD hearts flushed with C solution demonstrate complete recovery up to 20-min WIT after which there is rapid loss of viability. Cs extends the limit of WIT tolerability to 30 min. DCD hearts with 30-min WIT may be suitable for transplantation and warrant assessment in a transplant model.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Increasing the Tolerance of DCD Hearts to Warm Ischemia by Pharmacological Postconditioning

Iyer

Gao

Doyle

et al. 2014

American Journal of Transplantation

116

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“…Initial reperfusion with a cardioplegic solution inhibits the myocardial contractile unit at the onset of reoxygenation, facilitates the repletion of myocardial energy stores and restoration of intracellular ion homeostasis prior to myocardial contraction, and prevents the development of myocardial hypercontracture (12,13). However, these reparative processes may be inhibited if the cardioplegia is delivered under profoundly hypothermic conditions.…”

Section: Introductionmentioning

confidence: 99%

“…Hypothermia markedly lowers the activity of the ion pumps that are required to restore intracellular ion homeostasis in the DCD heart and may exacerbate ischemia-reperfusion injury (14)(15)(16)(17). Previous studies have suggested that the avoidance of profound hypothermia during initial reperfusion may support aerobic metabolism and improve functional recovery (12,18), yet the optimal temperature for the initial reperfusion of DCD hearts has not been previously investigated. Therefore, we sought to determine whether the avoidance of profound hypothermia during initial reperfusion would minimize myocardial injury and improve the functional recovery of DCD hearts during ex vivo heart perfusion (EVHP).…”

Section: Introductionmentioning

confidence: 99%

Avoidance of Profound Hypothermia During Initial Reperfusion Improves the Functional Recovery of Hearts Donated After Circulatory Death

White

Ambrose

Müller

et al. 2016

American Journal of Transplantation

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The resuscitation of hearts donated after circulatory death (DCD) is gaining widespread interest; however, the method of initial reperfusion (IR) that optimizes functional recovery has not been elucidated. We sought to determine the impact of IR temperature on the recovery of myocardial function during ex vivo heart perfusion (EVHP). Eighteen pigs were anesthetized, mechanical ventilation was discontinued, and cardiac arrest ensued. A 15-min standoff period was observed and then hearts were reperfused for 3 min at three different temperatures (58C; N ¼ 6, 258C; N ¼ 5, and 358C; N ¼ 7) with a normokalemic adenosine-lidocaine crystalloid cardioplegia. Hearts then underwent normothermic EVHP for 6 h during which time myocardial function was assessed in a working mode. We found that IR coronary blood flow differed among treatment groups (58C ¼ 483 AE 53, 258C ¼ 722 AE 60, 358C ¼ 906 AE 36 mL/ min, p < 0.01). During subsequent EVHP, less myocardial injury (troponin I: 58C ¼ 91 AE 6, 258C ¼ 64 AE 16, 358C ¼ 57 AE 7 pg/mL/g, p ¼ 0.04) and greater preservation of endothelial cell integrity (electron microscopy injury score: 58C ¼ 3.2 AE 0.5, 258C ¼ 1.8 AE 0.2, 358C ¼ 1.7 AE 0.3, p ¼ 0.01) were evident in hearts initially reperfused at warmer temperatures. IR under profoundly hypothermic conditions impaired the recovery of myocardial function (cardiac index: 58C ¼ 3.9 AE 0.8, 258C ¼ 6.2 AE 0.4, 358C ¼ 6.5 AE 0.6 mL/minute/g, p ¼ 0.03) during EVHP. We conclude that the avoidance of profound hypothermia during IR minimizes injury and improves the functional recovery of DCD hearts.Abbreviations: C a O 2 , oxygen content in arterial blood (aortic root); C v O 2 , oxygen content in venous blood (pulmonary artery); CBF, coronary blood flow; CVR, coronary vascular resistance; DCD, donation after circulatory death; dP/dt maximum, maximum rate of pressure change in the left ventricle; dP/dt minimum, minimum rate of pressure change in the left ventricle; EVHP, ex vivo heart perfusion; MVO 2 , myocardial oxygen consumption; P a O 2 , partial pressure of oxygen in arterial blood (aortic root); P v O 2 , partial pressure of oxygen in venous blood (pulmonary artery)

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“…Osaki et al [15] draw attention to the use of continuous myocardial perfusion for resuscitation of donor hearts, initially with blood cardioplegia at 20 ° C, and after, oxygenated blood at a temperature ranging from 20 ° to 37° C, which somehow is applied to the method described in this study. On the other hand, keeping the heart beating during the graft preservation showed better results when compared to preservation with hypothermia and cardioplegic solution at the University of Wisconsin, extending the preservation time safely and giving surgeons better means of assessing the applicability of this organ and facilitating long distance transport [8].…”

Section: Discussionmentioning

confidence: 99%

"Non Working Beating Heart"

Dinkhuysen¹,

Contreras²,

Cipullo³

et al. 2011

Rev Bras Cir Cardiovasc

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Background and Objective: We attempt to reduce the ischemic time during implantation of the donor heart in the bicaval bipulmonary orthotopic position using normothermic beating heart and thus, facilitate the transplanted heart adaptation to the recipient. This study presents a small experience about a new strategy of myocardial protection during heart transplant.Methods: In cardiopulmonary bypass, the aorta anastomosis was done first, allowing the coronary arteries to receive blood flow and the recovering of the beats. The rest of the anastomosis is performed on a beating heart in sinus rhythm. The pulmonary anastomosis is the last to be done. This methodology was applied in 10 subjects: eight males, age 16-69 (mean 32.7 years), SPAo 90-100 mmHg (mean 96 mmHg), SPAP 25-65 mmHg (mean 46.1 mmHg), PVR 0.9 to 5.0 Wood (mean 3.17 Wood), GTP 4-13 mmHg (mean 7.9 mmHg), and eight male donors, age 15-48 years (mean 27.7 years), weight 65-114 kg (mean 83.1 kg). Causes of brain coma: encephalic trauma in five hemorrhagic stroke in four, and brain tumor in one.Results: The ischemic time ranged from 58-90 minutes (mean 67.6 minutes) and eight donors were in hospitals of Sao Paulo and two in distant cities. All grafts assumed the cardiac output requiring low-dose inotropic therapy and maintained these conditions in the postoperative period. There were no deaths and all were discharged. The late evolution goes from 20 days to 10 months with one death occurred after 4 months due to sepsis.Conclusion: This method, besides reducing the ischemic time of the procedure, allows the donated organ to regain and maintain their beats without pre or after load during implantation entailing the physiological recovery of the graft.Descriptors: Ischemia. Heart transplantation. Cardiac surgical procedures. ResumoIntrodução e Objetivo: Trata-se do implante em posição ortotópica bicaval bipulmonar do coração doado batendo em normotermia. Este estudo busca diminuir o tempo isquêmico e criar condições de ir se adaptando ao organismo hospedeiro.Métodos: Já em CEC, a primeira anastomose a ser feita é a da aorta, reperfundindo as artérias coronárias e recuperando os batimentos. As restantes são realizadas com o coração batendo em ritmo sinusal, sendo a da artéria pulmonar a última. Esta metodologia foi aplicada em 10 pacientes receptores, sendo oito do sexo masculino, com RBCCV 44205-1331

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Resuscitation of Non-Beating Donor Hearts Using Continuous Myocardial Perfusion: The Importance of Controlled Initial Reperfusion

Abstract: The best recovery was observed in the non-beating donor hearts resuscitated by continuous myocardial perfusion when the initial controlled reperfusion with lukewarm blood cardioplegic solution at 40 mm Hg lasted for 20 minutes.

Cited by 49 publications

References 18 publications

Increasing the Tolerance of DCD Hearts to Warm Ischemia by Pharmacological Postconditioning

Increasing the Tolerance of DCD Hearts to Warm Ischemia by Pharmacological Postconditioning

Avoidance of Profound Hypothermia During Initial Reperfusion Improves the Functional Recovery of Hearts Donated After Circulatory Death

"Non Working Beating Heart"

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