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

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
C W WhiteD H Freed

Abstract

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 (5°C; N = 6, 25°C; N = 5, and 35°C; N = 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 (5°C = 483 ± 53, 25°C = 722 ± 60, 35°C = 906 ± 36 mL/min, p < 0.01). During subsequent EVHP, less myocardial injury (troponin I: 5°C = 91 ± 6, 25°C = 64 ± 16, 35°C = 57 ± 7 pg/mL/g, p = 0.04) and greater preservation of endothelial cell integrity (electron microscopy injury score: 5°C = 3.2 ± 0.5, 25°C = 1.8 ± 0.2, 35°C = 1.7 ± 0.3, p = 0.01) were evident in hearts initially reperfused at warmer tem...Continue Reading

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Citations

Oct 25, 2016·The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation·Diana García SáezAndre R Simon
Jan 19, 2016·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·P Macdonald
Aug 17, 2016·The Annals of Thoracic Surgery·Christopher WhiteDarren Freed
Apr 6, 2017·Current Opinion in Organ Transplantation·Kumud K DhitalPeter S Macdonald
Feb 28, 2017·Current Opinion in Cardiology·Michiel ErasmusLuciano Potena
Jul 19, 2018·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Maria N SanzSarah L Longnus
Mar 1, 2018·Frontiers in Cardiovascular Medicine·Christopher W WhiteDarren H Freed
Feb 23, 2019·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Eliana LucchinettiMichael Zaugg
Apr 19, 2019·Circulation. Heart Failure·Petra NiederbergerSarah L Longnus
Dec 15, 2017·Anesthesia and Analgesia·Rajat KalraNavkaranbir S Bajaj
Mar 30, 2021·Current Treatment Options in Cardiovascular Medicine·Calvin K W Tong, Kiran K Khush
Nov 20, 2020·Transplantation·Laura Anguela-CalvetEva Oliver-Juan

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