Abstract
Ex-situ heart perfusion preserves the donated heart in a perfused and semi-physiologic condition preventing preservation-related ischemia however, myocardial function declines overtime in this setting. All models of ex-situ heart perfusion (ESHP) position the heart in a suspended state which is at considerable variance with the in vivo positioning of the heart. In vivo, the aorta, vasculature and extracellular matrix support the myocardial mass. We hypothesize that the suspended myocardium may sustain greater injury and therefore may have greater decline in function compared to the supported myocardium. In this study, cardiac function and metabolism was assessed in healthy pig hearts, perfused for 12 hours, in either a conventional suspended position (susp) in which the heart is perfused suspending from the main vascular cannulas, or in a supported position (supp) in which the heart is perfused lying on a supporting membrane with integrated vascular cannulas (Figure 1). The hearts in each position were perfused either in non-working mode (NWM) or working mode (WM). Cardiac function was best preserved in the hearts perfused in a supported position in WM (relative 11-hour cardiac index / 1-hour cardiac index %: WM-supp=94.25 vs. NWM-supp=54.85, WM-susp=37.43, NWM-sup=11.17, p<0.001). Plasma cardiac troponin-I was significantly lower in supported-perfused compared to suspended-perfused hearts after 11 hours of perfusion (12.17 versus 20.80 ng/mL, p=0.001). Delivery of pyruvate bolus after 11 hours of perfusion, while leading to significant improvement of function in supported-perfused hearts, only partially recovered the myocardial function in the suspended-perfused groups (relative cardiac index %: supp= 100.31, susp= 41.50, p<0.001). ESHP in a semi-anatomical supported position, and physiologic, WM leads to less tissue injury and better preservation of myocardial function and viability.
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