title: Ex vivo resuscitation of adult pig hearts.
abstract: One possible way to expand the human heart donor pool is to include non-heart-beating human donors. To begin validating this approach, we developed an ex vivo cardiac perfusion circuit to support large mammalian hearts in Langendorff mode and beating-ejecting mode and to assess and improve their ischemic tolerance. In vivo hemodynamic data and heparinized blood (4.0 +/- 0.5 L) were collected from 6 anesthetized pigs. Hearts were isolated and connected to a recirculating perfusion circuit primed with autologous buffered blood (pH, 7.40). After retrograde aortic perfusion in Langendorff mode, the left atrium was gravity-filled at 10-20 mmHg, and the left ventricle began to eject against a compliance chamber in series with a systemic reservoir set to a hydraulic afterload of 100-120 mmHg. Left ventricular function was restored and maintained in all 6 hearts for 30 min. Cardiac output, myocardial oxygen consumption, stroke work, aortic pressure, left atrial pressure, and heart rate were measured. The mean myocardial oxygen consumption was 4.8 +/- 2.7 mL/min/100 g (95.8% of in vivo value); and mean stroke work, 5.3 +/- 1.1 g x m/100 g (58.95% of in vivo value). One resuscitated heart was exposed to 30 min of normothermic ischemic arrest, then flushed with Celsior and re-resuscitated. The ex vivo perfusion method described herein restored left ventricular ejection function and allowed assessment of ischemic tolerance in large mammalian hearts, potentially a 1st step toward including non-heart-beating human donors in the human donor pool.
authors.affiliation: Cullen Cardiovascular Research Laboratories, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77030, USA. Doreen.Rosenstrauch@uth.tmc.edu
authors.forename: Doreen
authors.initials: D
authors.lastname: Rosenstrauch
authors.forename: Hakan M
authors.initials: HM
authors.lastname: Akay
authors.forename: Hakki
authors.initials: H
authors.lastname: Bolukoglu
authors.forename: Lars
authors.initials: L
authors.lastname: Behrens
authors.forename: Laura
authors.initials: L
authors.lastname: Bryant
authors.forename: Peter
authors.initials: P
authors.lastname: Herrera
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Eya
authors.forename: Egemen
authors.initials: E
authors.lastname: Tuzun
authors.forename: Fred J
authors.initials: FJ
authors.lastname: Clubb
authors.forename: Branislav
authors.initials: B
authors.lastname: Radovancevic
authors.forename: O H
authors.initials: OH
authors.lastname: Frazier
authors.forename: Kamuran A
authors.initials: KA
authors.lastname: Kadipasaoglu
mesh_terms: D000818:Animals; D002302:Cardiac Output; D005112:Extracorporeal Circulation; D006323:Heart Arrest / Q000503:physiopathology / Q000628:therapy; D006439:Hemodynamics; D066298:In Vitro Techniques; D017202:Myocardial Ischemia / Q000503:physiopathology; D010101:Oxygen Consumption; D012151:Resuscitation; D013318:Stroke Volume; D013552:Swine; D016277:Ventricular Function, Left