title: Preservation of the donor heart: from basic science to clinical studies.
abstract: The methods of donor heart preservation are aimed at minimizing graft dysfunction caused by ischaemia-reperfusion injury (IRI) which inevitably occurs during the ex vivo transport interval. At present, the standard technique of heart preservation is cardiac arrest followed by static cold storage in a crystalloid heart preservation solution (HPS). This technique ensures an acceptable level of heart protection against IRI for <6 h. In clinical trials, comparable levels of myocardial protection against IRI were provided by various HPSs. The growing shortage of donor hearts is one of the major factors stimulating the development of new techniques of heart preservation. Here, we summarize new HPS formulations and provide a focus for optimization of the composition of existing HPSs. Such methods of donor heart preservation as machine perfusion, preservation at sub-zero temperature and oxygen persufflation are also discussed. Furthermore, we review experimental data showing that pre- and post-conditioning of the cardiac graft can improve its function when used in combination with cold storage. The evidence on the feasibility of cardiac donation after circulatory death, as well as the techniques of heart reconditioning after a period of warm ischaemia, is presented. The implementation of new techniques of donor heart preservation may contribute to the use of hearts from extended criteria donors, thereby expanding the total donor pool.
authors.affiliation: Institute of Experimental Medicine, Federal Almazov Medical Research Centre, St Petersburg, Russian Federation Department of Pathophysiology, First Pavlov State Medical University of St Petersburg, St Petersburg, Russian Federation.
authors.forename: Sarkis M
authors.initials: SM
authors.lastname: Minasian
authors.affiliation: Institute of Experimental Medicine, Federal Almazov Medical Research Centre, St Petersburg, Russian Federation Department of Pathophysiology, First Pavlov State Medical University of St Petersburg, St Petersburg, Russian Federation galagoudza@mail.ru.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Galagudza
authors.affiliation: Institute of Experimental Medicine, Federal Almazov Medical Research Centre, St Petersburg, Russian Federation.
authors.forename: Yuri V
authors.initials: YV
authors.lastname: Dmitriev
authors.affiliation: Institute of Experimental Medicine, Federal Almazov Medical Research Centre, St Petersburg, Russian Federation Department of Pathophysiology, First Pavlov State Medical University of St Petersburg, St Petersburg, Russian Federation.
authors.forename: Andrey A
authors.initials: AA
authors.lastname: Karpov
authors.affiliation: Institute of Experimental Medicine, Federal Almazov Medical Research Centre, St Petersburg, Russian Federation Department of Pathophysiology, First Pavlov State Medical University of St Petersburg, St Petersburg, Russian Federation.
authors.forename: Timur D
authors.initials: TD
authors.lastname: Vlasov
mesh_terms: D000818:Animals; D003080:Cold Temperature; D006085:Graft Survival; D016027:Heart Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D015428:Myocardial Reperfusion Injury / Q000209:etiology / Q000517:prevention & control*; D009926:Organ Preservation / Q000009:adverse effects / Q000379:methods*; D019188:Organ Preservation Solutions / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D016896:Treatment Outcome
chemical_list: D019188:Organ Preservation Solutions
keywords: Cardioprotection; Cold storage; Donor heart preservation; Myocardial ischaemia–reperfusion injury; Preservation solutions