Superior Donor Heart Preservation Using Hypothermic Oxygenated Perfusion.

Abstract

Purpose Hypothermic machine perfusion of donor hearts enables continuous aerobic metabolism and washout of toxic metabolic byproducts. We evaluated the effect of machine perfusion on cardiac myocyte integrity in hearts preserved for 4 hours in a novel device that provides pulsatile oxygenated hypothermic perfusion (Paragonix Sherpa PerfusionTM Cardiac Transport System). Methods All pig hearts were perfused with 1L of cold Celsior® solution after aortic cross-clamping, and then harvested. They were stored conventionally in Celsior® solution on ice for 4 hours (Celsior® storage [CS], n=6) or placed in the Sherpa device for 4 hours (pulsatile perfusion [PP], n=6). After cold preservation, hearts were evaluated hemodynamically using a Langendorff system. Systolic function was measured by +dP/dt; and diastolic function was measured by -dP/dt and EDP. Three control swine hearts were also re-perfused and evaluated immediately after harvest on the Langendorff system. Biopsies were taken from the LV apex at the time of harvest, after storage (when relevant), and after reperfusion for ultra-structural analysis using electron microscopy. Results CS, PP, and control hearts did not show any significant differences in systolic or diastolic function (+dP/dt, -dP/dt, EDP). CS hearts had more arrhythmias (supraventricular and ventricular) compared to PP and control hearts. Electron microscopy revealed endothelial cell rupture and damaged muscle fibers in the CS group after reperfusion, while the cell structures were preserved in the PP group and the control group. After preservation, PP hearts showed mild edema, which was not present in CS hearts, but after reperfusion, both groups had a similar grade of interstitial edema. Conclusions Hypothermic pulsatile perfusion of donor hearts during the storage interval is a simple technique that leads to better preservation of cell structure, as compared to a conventional cold storage method. This may lead to less risk of primary graft failure after orthotopic heart transplantation. Donor hearts preserved with pulsatile perfusion also appear less prone to arrhythmias during the reperfusion period. DISCLOSURES:Anderson, L.: Other, Paragonix Technologies, President. Madsen, J.: Grant/Research Support, Paragonix Technologies.