Emergency donor heart protection: application of the port access catheter technique using a pig heart transplantation model.
BACKGROUND
Organ shortage limits the number of transplantations, and donor deterioration may precede and often prevent conventional organ preservation. This study evaluates in situ perfusion as a bedside method for cardiac allograft procurement in a large animal model.


METHODS
Thirty Landrace pigs (42 +/- 7 kg) were studied. The hearts in the conventional group underwent cardioplegic arrest with University of Wisconsin solution and sodium-hydrogen exchange inhibitor cariporide as an additive; they were explanted and stored on ice before transplantation. In the in situ group, one catheter was placed in the ascending aorta and another in the right atrium. After disconnection from the ventilator, hypoxia caused circulatory arrest. The aorta was endoclamped, and in situ perfusion of the aortic root was maintained with University of Wisconsin solution and cariporide. After explantation, hearts were stored on ice for 120 min. All hearts were implanted according to the Shumway technique. Ventricular pressure and cardiac output were monitored online, and troponin-I was measured intermittently. Two hours after weaning from extracorporal circulation, the animals were killed and histology was performed.


RESULTS
Catheters were placed through introducers within 5 min. Functional recovery and histology were comparable between the two techniques. Troponin-I increased in both groups during reperfusion but at a faster rate in the in situ technique (P <0.01).


CONCLUSIONS
In situ perfusion may be suitable for cardiac transplants when donor deterioration requires urgent organ preservation. Catheters can be placed at bedside and modified to achieve multi-organ protection through additional perfusion of the abdominal aorta.
Scheule
Albertus M
AM
Department of Thoracic, Cardiac and Vascular Surgery, Tuebingen University Hospital, Tuebingen, Germany. albertus.scheule@med.uni-tuebingen.de
Beierlein
Wolfram
W
Zurakowski
David
D
Jost
Dominik
D
Haas
Jens
J
Vogel
Ulrich
U
Miller
Stefan
S
Wendel
Hans-Peter
HP
Ziemer
Gerhard
G
D000241:Adenosine; D000493:Allopurinol; D000818:Animals; D002314:Cardioplegic Solutions; D002404:Catheterization / Q000379:methods; D004630:Emergencies; D005978:Glutathione; D006146:Guanidines; D006321:Heart; D016027:Heart Transplantation; D006801:Humans; D066298:In Vitro Techniques; D007328:Insulin; D023421:Models, Animal; D009926:Organ Preservation / Q000379:methods*; D019188:Organ Preservation Solutions; D010477:Perfusion; D011887:Raffinose; D013450:Sulfones; D034421:Sus scrofa; D014019:Tissue Donors; D009927:Tissue and Organ Procurement
D002314:Cardioplegic Solutions; D006146:Guanidines; D007328:Insulin; D019188:Organ Preservation Solutions; D013450:Sulfones; C055206:University of Wisconsin-lactobionate solution; D000493:Allopurinol; C093373:cariporide; D005978:Glutathione; D000241:Adenosine; D011887:Raffinose