The Basic Science Aspect of Donor Heart Preservation: A Review

Abstract

In cardiac transplantation, the transport time between harvest and recipient is limited by the viability of the donor heart. The problem of viability is a consistent limitation in cardiac transplantation. Since the 1960s, techniques, including hypothermia, perfusion, oxygenation, and hyperbaria, have been used to prolong the preservation of the transplantable heart. Continuing development of cardioplegic solutions has minimized edema and oxygen radical formation, which have resulted in extension of the donor heart viability. New research into the events leading to necrosis, oncosis, and apoptosis may allow further advancement of protective cardioplegic solutions in combination with technology of transporting the heart. With a prolonged preservation time there is potential to increase the donor pool and ultimately improve post-operative outcomes.

Experimental and Clinical Studies in Ruptured Abdominal Aortic Aneurysm : Aspects of Hypothermia and Endovascular Treatment

“…81 These experiences led to adopting hypothermia during cardiothoracic surgery, neurosurgery and in neonatal care. [82][83][84][85] Induced mild hypothermia has not shown any benefit on survival for patients with out of hospital cardiac arrest. Induced hypothermia is assumed to protect the cell function when oxygen transport to the cell is impaired for any reason.…”

Donor Heart Preservation: Current Knowledge and the New Era of Machine Perfusion

“…One of the main limitations in heart transplantation is the problem of viability of the donor heart since there is a certain transport time between donor explantation and recipient implantation, as the use of the donor heart has been limited by the ischemic time of 4 to 6 h [5]. Several techniques have been used to prolong the preservation of the transplantable heart, with perfusion, oxygenation, hyberbaria, and hypothermia being the main ones [6]. Since the first successful heart transplantation in 1967, cold ischemic preservation of the donor heart in a crystalloid solution at 4 • C is the gold standard for myocardial protection, given the fact that this method is inexpensive, easily reproducible, and technically simple [7].…”

“…Normally, adenosine triphosphate (ATP) is the primary energy source. In prolonged cold storage, ATP is depleted in catabolic action and as a sequala, metabolites are formed, leading eventually to the appearance of necrosis [6].…”

“…The commonly used cardioplegic solutions contain various metabolic and oncotic agents, which prevent necrosis and edema formation. However, there are problems related to cellular metabolism in the context of cold storage, organ ischemia, and reperfusion [6].…”