Feasibility Study of Pulsatile Left Ventricular Assist Device for Prolonged Ex Vivo Lung Perfusion.
BACKGROUND
Ex vivo lung perfusion (EVLP) has the potential to increase the donor pool for lung transplantation by facilitating resuscitation and extended evaluation of marginal organs. Current EVLP methodology employs continuous flow (CF) pumps that produce non-pulsatile EVLP hemodynamics. In this feasibility study, we tested the hypothesis that a pulsatile flow (PF) pump will provide better EVLP support than a CF pump through delivery of physiologic hemodynamics.


METHODS
Porcine lungs were supported in an EVLP model by centrifugal CF (n = 3) or PF (n = 4) left ventricular assist devices. Lungs were ventilated at 4 to 5 mL/kg, 0.21 fraction of inspired oxygen (FiO2), and perfused with an acellular, albumin-based solution corrected for osmolarity, acid-base balance, and carbon dioxide pressure (≤20 hours at 30°C) for a minimum of 12 hours support. Prostaglandin E1 and 30% albumin were infused continuously. Hemodynamic, respiratory, and blood gas parameters were continuously monitored and digitally recorded hourly. Parenchymal biopsies were used for quantification of wet to dry weight ratio.


RESULTS
All lungs maintained function in the EVLP circuit for a minimum of 12 hours (mean 14.7 ± 1 hours) and demonstrated minimal edema formation. The PF EVLP produced higher pulsatility as demonstrated by greater energy equivalent pressure and surplus hemodynamic energy compared with CF EVLP (p < 0.05). There were no statistically significant differences in pulmonary impedance, arterial partial pressure of oxygen/fraction of inspired oxygen, wet to dry weight ratio, and peak airway pressure between CF and PF EVLP.


CONCLUSIONS
The CF and PF EVLP systems successfully maintained lungs 12+ hours using a modified Steen perfusate (XVIVO Perfusion, Inc, Goteborg, Sweden); however, there were no statistically significant differences between CF and PF groups despite higher pulsatility, suggesting that PF may not offer immediate benefits over CF for prolonged ex vivo lung preservation.
Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky.
Erin M
EM
Schumer
Department of Bioengineering, University of Louisville, Louisville, Kentucky.
Keith A
KA
Zoeller
Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky.
Paul L
PL
Linsky
Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky.
Gretel
G
Monreal
Department of Bioengineering, University of Louisville, Louisville, Kentucky.
Young
Y
Choi
Department of Bioengineering, University of Louisville, Louisville, Kentucky.
Guruprasad A
GA
Giridharan
Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky.
Michael A
MA
Sobieski
Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky; Department of Bioengineering, University of Louisville, Louisville, Kentucky.
Mark S
MS
Slaughter
Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky. Electronic address: victor.vanberkel@louisville.edu.
Victor H
VH
van Berkel
D000818:Animals; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000601:surgery*; D006353:Heart-Assist Devices; D008168:Lung / Q000502:physiology*; D016040:Lung Transplantation / Q000379:methods*; D008297:Male; D009926:Organ Preservation / Q000379:methods*; D010477:Perfusion / Q000379:methods*; D011474:Prosthesis Design; D011673:Pulsatile Flow / Q000502:physiology; D013552:Swine; D013997:Time Factors; D014019:Tissue Donors