TY - JOUR
T1 - A Cardioprotective perfusion protocol limits myocardial functional decline during ex situ heart perfusion
AU - Vervoorn, Mats T.
AU - Ballan, Elisa M.
AU - van Tuijl, Sjoerd
AU - de Jager, Saskia C.A.
AU - Kaffka genaamd Dengler, Selma E.
AU - Sluijter, Joost P.G.
AU - Doevendans, Pieter A.
AU - van der Kaaij, Niels P.
PY - 2024
Y1 - 2024
N2 - Background Ex situ heart perfusion is associated with a significant decline in graft quality related to oxidative stress, inflammation, endothelial dysfunction, and metabolic perturbations. We assessed the effects of a more optimized, cardioprotective normothermic perfusion approach compared to a conventional perfusion protocol in a slaughterhouse model using porcine hearts. Methods A total of 12 hearts were harvested and subjected to 4 hours of normothermic perfusion. The optimized protocol consisted of an adenosine-lidocaine cardioplegic solution, subnormothermic initial reperfusion and controlled rewarming, hemofiltration and supplementation of methylprednisolone and pyruvate. This was compared to a conventional protocol consisting of St. Thomas II cardioplegic solution, normothermic initial reperfusion without hemofiltration or methylprednisolone, and a mixture of glucose and insulin for metabolic support. Results Myocardial function was superior in the optimized group, while significant functional decline was absent. Hearts subjected to the conventional protocol demonstrated a significant reduction in function over time. Conclusions We have developed a further optimized, cardioprotective normothermic ex situ heart perfusion approach and demonstrated significantly improved myocardial function and attenuated functional decline during 4 hours of normothermic perfusion, indicating improved preservation.
AB - Background Ex situ heart perfusion is associated with a significant decline in graft quality related to oxidative stress, inflammation, endothelial dysfunction, and metabolic perturbations. We assessed the effects of a more optimized, cardioprotective normothermic perfusion approach compared to a conventional perfusion protocol in a slaughterhouse model using porcine hearts. Methods A total of 12 hearts were harvested and subjected to 4 hours of normothermic perfusion. The optimized protocol consisted of an adenosine-lidocaine cardioplegic solution, subnormothermic initial reperfusion and controlled rewarming, hemofiltration and supplementation of methylprednisolone and pyruvate. This was compared to a conventional protocol consisting of St. Thomas II cardioplegic solution, normothermic initial reperfusion without hemofiltration or methylprednisolone, and a mixture of glucose and insulin for metabolic support. Results Myocardial function was superior in the optimized group, while significant functional decline was absent. Hearts subjected to the conventional protocol demonstrated a significant reduction in function over time. Conclusions We have developed a further optimized, cardioprotective normothermic ex situ heart perfusion approach and demonstrated significantly improved myocardial function and attenuated functional decline during 4 hours of normothermic perfusion, indicating improved preservation.
KW - ex situ heart perfusion
KW - heart transplantation
KW - heart failure
KW - cardiac surgery
KW - organ preservation
KW - machine perfusion
U2 - 10.1016/j.jhlto.2023.100042
DO - 10.1016/j.jhlto.2023.100042
M3 - Article
SN - 2950-1334
VL - 3
JO - JHLT Open
JF - JHLT Open
M1 - 100042
ER -