Human Hearts Declined for Transplant Were Resuscitated on the Visible Heart® Apparatus

Abstract

Purpose Improved utilization of donor hearts would benefit chronic heart failure patients awaiting transplant. Limitations to cardiac allograft preservation include ischemic time, donor organ quality, and accurate graft assessment. We hypothesized that human hearts declined for transplant may be resuscitated after varied ischemic times. The unique studies performed within the Visible Heart® Laboratory for over two decades have provided unique insights relative to optimizing large mammalian functions post-cardioplegia. Methods Human hearts declined for transplant were utilized for research at the Visible Heart® Laboratory in coordination with the local organ procurement organization. Donor hearts were procured in standard fashion using 2L cardioplegia solution, and storage on ice. Hearts were delivered within 4-10 hours and cannulated for perfusion in Langendorf, right-sided, or 4-chamber working modes. Next, hearts were perfused with a warmed, oxygenated Kreb-Henseleit perfusate. These hearts were deemed non-viable for transplant for a variety of factors. Hemodynamic parameters, functional endoscopic videos, and electrocardiographic parameters have been recorded. All hearts were perfusion-fixed in formaldehyde and preserved in the Visible Heart® Library. Results Eighty-three human hearts declined for transplant were reanimated on the Visible Heart® Apparatus: varied hemodynamic functions were recorded. Average donor age was 57 years (7 to 91 yrs). Fifty percent (50%) of donors were female. Average cold ischemic time was 402 minutes (126-678 minutes). All hearts achieved pulsatile perfusion, and evidence of EKG rhythm. Conclusion This work demonstrates the unique capabilities of the Visible Heart® Laboratory: the abilities to reanimate human hearts and investigate relative electrophysioligical and hemodynamic behaviors has utility for determining if some human hearts declined for transplant were in fact viable, or could benefit from post-conditoning. Hence, this work provides encouragement for expanding the utilization of donor hearts available for transplant. Future work will focus on improved preservation techniques (i.e., various cardioplegia agents, warm perfusion vs cold storage), novel pharmacologic pre- and post-conditioning agents, and improved assessment of donor hearts during preservation. Improved utilization of donor hearts would benefit chronic heart failure patients awaiting transplant. Limitations to cardiac allograft preservation include ischemic time, donor organ quality, and accurate graft assessment. We hypothesized that human hearts declined for transplant may be resuscitated after varied ischemic times. The unique studies performed within the Visible Heart® Laboratory for over two decades have provided unique insights relative to optimizing large mammalian functions post-cardioplegia. Human hearts declined for transplant were utilized for research at the Visible Heart® Laboratory in coordination with the local organ procurement organization. Donor hearts were procured in standard fashion using 2L cardioplegia solution, and storage on ice. Hearts were delivered within 4-10 hours and cannulated for perfusion in Langendorf, right-sided, or 4-chamber working modes. Next, hearts were perfused with a warmed, oxygenated Kreb-Henseleit perfusate. These hearts were deemed non-viable for transplant for a variety of factors. Hemodynamic parameters, functional endoscopic videos, and electrocardiographic parameters have been recorded. All hearts were perfusion-fixed in formaldehyde and preserved in the Visible Heart® Library. Eighty-three human hearts declined for transplant were reanimated on the Visible Heart® Apparatus: varied hemodynamic functions were recorded. Average donor age was 57 years (7 to 91 yrs). Fifty percent (50%) of donors were female. Average cold ischemic time was 402 minutes (126-678 minutes). All hearts achieved pulsatile perfusion, and evidence of EKG rhythm. This work demonstrates the unique capabilities of the Visible Heart® Laboratory: the abilities to reanimate human hearts and investigate relative electrophysioligical and hemodynamic behaviors has utility for determining if some human hearts declined for transplant were in fact viable, or could benefit from post-conditoning. Hence, this work provides encouragement for expanding the utilization of donor hearts available for transplant. Future work will focus on improved preservation techniques (i.e., various cardioplegia agents, warm perfusion vs cold storage), novel pharmacologic pre- and post-conditioning agents, and improved assessment of donor hearts during preservation.