Twenty-four-hour normothermic perfusion of isolated ex vivo hearts using plasma exchange

Prolonged (24-hour) Normothermic ex vivo Heart Perfusion Facilitated by Perfusate Hemofiltration

“…13 The only reports of successful ≥24-hour NEVHP are from our group. 2,3 We previously demonstrated routinely successful NEVHP for 3 days using blood perfusate combined with plasma cross-circulation with a paracorporeal animal. 2 In this study, all NEVHP hemofiltration hearts were viable and maintained adequate function for a minimum of 24 hours.…”

“…Aortic blood flows were slowly increased and adjusted to maintain coronary blood flow between 0.7 and 1.2 ml per minute per gram of cardiac tissue (mL/min/g) with a mean flow of 1.0 ± 0.01 ml/min/g concordant with physiologic coronary blood flow. 3,4 PA outflow and LV drainage were collected and returned to the reservoir of the perfusion circuit. The LV balloon was inflated to maintain end-diastolic pressure within 10-12 mm Hg.…”

“…2 More recently, we achieved 24-hour NEVHP using plasma exchange without a paracorporeal animal. 3 These studies indicate that prolonged NEVHP is possible if critical factors present in plasma are added or removed from the perfusate. In the paracorporeal system, the removed plasma is circulated through the host animal allowing filtration to occur through the host's hepatorenal system before returning to the ex vivo perfusate.…”

Artificial Intelligence-Assisted Strain Echocardiography in an Ex Vivo Heart

“…We developed a prolonged normothermic ex vivo heart perfusion (NEVHP) model that maintains cardiac function for 24 hours or longer. 2,3 These studies have led to successful transplantation following 24 hours of NEVHP. Prolonged NEVHP requires meticulous antisepsis.…”

Commentary: Plasma exchange during extended normothermic ex vivo perfusion of donor hearts may lead to the Holy Grail of nonemergency transplantation!

“…It was appreciated, however, that this paracorporeal animal model would not be clinically realistic. Hence, in the present, proof-of-concept, study, 3 this group explored the feasibility of maintaining ex vivo donor piglet hearts by continuous 24-hour blood perfusion and plasma exchange without the use of a paracorporeal animal. Plasma exchange involves the controlled addition of plasma (extracted from pooled porcine blood and infused at a rate of 1 mL/h/kg) to an isolated heart perfusion circuit filled with donor blood and from which plasma was removed at the same rate, using a commercially available plasma separator.…”