Eight-Hour Ex Situ Perfusion with Functional Assessment of an Adult Heart after 12 Hours Hypothermic Preservation: A Case Study

Abstract

Ex situ heart perfusion (ESHP) allows resuscitation and functional assessment of marginal donor hearts to expand the donor pool. The current clinically available ESHP platform does not enable contractile assessment. We sought to determine if a marginal donor heart could be resuscitated and assessed on our custom ESHP system following an extended period of cold storage. Organ procurement and preservation were performed according to our current clinical protocol, utilizing Celsior as the preservation solution. The ESHP system was primed with 750mL of Steen (XVIVO Perfusion) and 750mL of SOM-TRN-001 (Somahlution). Isolated O negative red blood cells were added to achieve a hematocrit of 15%. Dobutamine 5mcg/min, Insulin 5u/h, and Nitroglycerin 1mcg/kg/min were infused continuously through ESHP. The perfusate was continuously dialyzed through an arterial line shunt to the venous reservoir at a rate of 300 ml/min. Blood gas was measured every two hours. Heart was transitioned to working mode at 8 hours by loading the atria at 8mmHg and functional assessment was performed PV catheter. A 67-year-old male donor heart with mild proximal one vessel coronary artery disease was procured, harvested and transported in cold storage for 12 hours until the organ was reperfused in our ESHP system. Following reanimation, the heart was perfused for 8 hours. Electrolytes were maintained within physiological range throught the ESHP period under the regulation of hemodialysis. Continously lactate consumption (Table I) indicates the heart's metabolism is working. PRSW, maximum (Emax) and end-systolic (Ees) elastance show the cardiac function measured at the end of of ESHP. We describe a successful resuscitation and ex situ pefusion of a marginal donor heart with 12 hours cold ischemia time. The feasibility of this method hypothesis is a promising strategy which can preclude the need for cumbersome and resource intense transport platforms.