FUNCTIONAL ASSESSMENT OF DCD HEARTS FOLLOWING NORMOTHERMIC REGIONAL PERFUSION CAN PREDICT POST-TRANSPLANTATION CONTRACTILITY

Abstract

Procurement of DCD hearts using normothermic regional perfusion (NRP) leads to rapid organ reperfusion and allows for a complete cardiac assessment in situ, ensuring only suitable hearts are procured. We aimed to identify which parameters measured following NRP could predict myocardial performance post-transplantation. Donor pigs underwent hypoxic circulatory arrest followed by 15min of warm ischemia and resuscitation with NRP. They underwent 3h of cold ischemia, transplantation, and reperfusion for 3h. We assessed cardiac function using left ventricular (LV) pressure-volume loops, right ventricular (RV) catheterization, and echocardiography following NRP and at 3h of reperfusion. Lactate levels at the time of arrest and time from withdrawal of care to arrest were measured. We performed linear regressions to identify correlations post-transplant cardiac performance. Predictors and outcomes were analyzed as absolute and relative (% from baseline) values. Relative LV fractional area change was the best predictor of relative preload recruitable stroke work (R2=0.754; p=0.002). Lactate concentration immediately before NRP also was a good predictor of relative stroke work (R2=0.788; p < 0.001). Relative and absolute RV stroke work index (SWI) and RV S’, and time to arrest were predictors of recovery in RV function. Only RV functional parameters were capable of predicting global myocardial performance following transplantation. RV S’ showed the strongest correlation with absolute (R2=0.540; p=0.01) and relative (R2=0.500; p=0.022) cardiac index (Table 1). Contractility and biochemical markers measured before heart procurement seemed to predict myocardial performance accurately. Functional parameters demonstrated a more significant number of correlations and provided a better evaluation following NRP. It is of critical importance to also assess DCD heart function to determine organ suitability before transplantation.