Right Ventricular Distension in Donor Hearts Following Cardiocirculatory Death: Implications for Post-Transplant Function

White, Christopher W.; Ali, Ayyaz; Hasanally, Devin; Wang, F.; Xiang, Bo; Mundt, P.; Large, Stephen; Ravandi, Amir; Lee, T.W.; Arora, Rakesh C.; Tian, Ganghong; Freed, Darren H.

doi:10.1016/j.healun.2013.01.1003

Cited by 3 publications

(5 citation statements)

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“…In addition, in the recipient animal in which we were able to obtain more detailed functional assessments, there was evidence of biventricular diastolic dysfunction particularly involving the right ventricle. This is not unexpected as marked RV distension has been reported during withdrawal of life support and may exacerbate myocardial injury . This finding has implications for clinical translation and suggests that DCD hearts may not be suitable for recipients with an elevated pulmonary vascular resistance .…”

Section: Discussionmentioning

confidence: 76%

“…Organ donation via the DCD pathway is associated with variable periods of warm ischemia. The period between withdrawal of life support and administration of organ preservation solution, referred to as the warm ischemic time (WIT), exposes the heart to the triple insults of hypoxia, hypo‐perfusion and cardiac distension . Beyond the WIT, the donor heart is subjected to further insults—during storage and again at the time of reperfusion.…”

Section: Introductionmentioning

confidence: 99%

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Normothermic Ex Vivo Perfusion Provides Superior Organ Preservation and Enables Viability Assessment of Hearts From DCD Donors

Iyer

Gao

Doyle

et al. 2015

American Journal of Transplantation

119

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The shortage of donors in cardiac transplantation may be alleviated by the use of allografts from donation after circulatory death (DCD) donors. We have previously shown that hearts exposed to 30 min warm ischemic time and then flushed with Celsior supplemented with agents that activate ischemic postconditioning pathways, show complete recovery on a blood-perfused ex vivo working heart apparatus. In this study, these findings were assessed in a porcine orthotopic heart transplant model. DCD hearts were preserved with either normothermic ex vivo perfusion (NEVP) using a clinically approved device, or with standard cold storage (CS) for 4 h. Orthotopic transplantation into recipient animals was subsequently undertaken. Five of six hearts preserved with NEVP demonstrated favorable lactate profiles during NEVP and all five could be weaned off cardiopulmonary bypass posttransplant, compared with 0 of 3 hearts preserved with CS (p < 0.05, Fisher's exact test). In conclusion, DCD hearts flushed with supplemented Celsior solution and preserved with NEVP display viability before and after transplantation. Viability studies of human DCD hearts using NEVP are warranted.

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Section: Discussionmentioning

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Normothermic Ex Vivo Perfusion Provides Superior Organ Preservation and Enables Viability Assessment of Hearts From DCD Donors

Iyer

Gao

Doyle

et al. 2015

American Journal of Transplantation

119

View full text Add to dashboard Cite

show abstract

“…Raina et al described that combining the parameters, such as preoperative lower RV fractional area change and higher estimated RAP, allowed prediction of RV failure after LV assist device placement, which affected the PVR 11 . White et al reported the transition in RV pressure and volume of DCD hearts using conductance catheter examination and magnetic resonance imaging during the agonal period 17 . A rapid decrease in arterial oxygen partial pressure coincided with an increase in RV systolic pressure and in diastolic and systolic functions, leading to a decline in the RV function and an eventual extension in the RV end‐diastolic phase.…”

Section: Discussionmentioning

confidence: 99%

“…11 White et al reported the transition in RV pressure and volume of DCD hearts using conductance catheter examination and magnetic resonance imaging during the agonal period. 17 A rapid decrease in arterial oxygen partial pressure coincided with an increase in RV systolic pressure and in diastolic and systolic functions, leading to a decline in the RV function and an eventual extension in the RV end-diastolic phase. This observation suggests that DCD hearts may not be compatible for recipients with elevated PVR.…”

Section: Rv Failurementioning

confidence: 99%

Ex vivo evaluation of the biventricular cardiac function for donation after circulatory death model: An experimental study

et al. 2020

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Few reports on a biventricular working heart model with ex vivo perfusion exist owing to the complexity of establishing a circuit. Hence, we investigated it for donation after circulatory death. The heart in six juvenile pigs (~20 kg) was arrested by asphyxiation. After 30 minutes of global ischemia, the heart was harvested, reperfused with normoxemic blood cardioplegia for 20 minutes, and subsequently perfused with hyperxemic blood. After 70 minutes of controlled reperfusion, the system was switched to the biventricular working mode. Cardiac function was assessed before anoxia and during the biventricular mode. Left and right ventricular functions worsened during the biventricular mode, as compared to those before anoxia (dP/dt max , 673 ± 120 vs. 283 ± 95 and 251 ± 35 vs. 141 ± 21 mm Hg/s, respectively; P < .001). Systemic (resistance/100 g net heart weight) and pulmonary vascular resistance indexes during the biventricular mode were similar to those before anoxia (829 ± 262 vs. 759 ± 359, P = .707, and 167 ± 57 vs. 158 ± 83 dynes•sec•cm-5l-100-g net heart weight, P = .859, respectively). The biventricular working heart model with ex vivo perfusion was feasible, exhibited stable hemodynamics, and has the potential to be a powerful tool for direct cardiac function assessment.

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“…The risk of cardiac dysfunction escalates with the time for which the heart is exposed to warm ischemia. Prolonged warm ischemic time (WIT), defined as the time period between withdrawal of life support and administration of organ preservation solution, puts the heart at a great risk of hypoxia, hypo-perfusion, and cardiac distention [ 16 , 17 ].…”

Section: Factors To Be Considered In Nhbdsmentioning

confidence: 99%

Non-Heart-Beating Donor Heart Transplantation: Breaking the Taboo

Fatullayev

Samak

Sabashnikov

et al. 2015

Med Sci Monit Basic Res

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Roughly 60% of hearts offered for transplantation are rejected because of organ dysfunction. Moreover, hearts from circulatory-dead patients have long been thought to be non-amenable for transplantation, unlike other organs. However, tentative surgical attempts inspired by the knowledge obtained from preclinical research to recover those hearts have been performed, finally culminating in clinically successful transplants. In this review we sought to address the major concerns in non-heart-beating donor heart transplantation and highlight recently introduced developments to overcome them.

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Right Ventricular Distension in Donor Hearts Following Cardiocirculatory Death: Implications for Post-Transplant Function

Cited by 3 publications

References 0 publications

Normothermic Ex Vivo Perfusion Provides Superior Organ Preservation and Enables Viability Assessment of Hearts From DCD Donors

Normothermic Ex Vivo Perfusion Provides Superior Organ Preservation and Enables Viability Assessment of Hearts From DCD Donors

Ex vivo evaluation of the biventricular cardiac function for donation after circulatory death model: An experimental study

Non-Heart-Beating Donor Heart Transplantation: Breaking the Taboo

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