title: Assessment of donor heart viability during ex vivo heart perfusion.
abstract: Ex vivo heart perfusion (EVHP) may facilitate resuscitation of discarded donor hearts and expand the donor pool; however, a reliable means of demonstrating organ viability prior to transplantation is required. Therefore, we sought to identify metabolic and functional parameters that predict myocardial performance during EVHP. To evaluate the parameters over a broad spectrum of organ function, we obtained hearts from 9 normal pigs and 37 donation after circulatory death pigs and perfused them ex vivo. Functional parameters obtained from a left ventricular conductance catheter, oxygen consumption, coronary vascular resistance, and lactate concentration were measured, and linear regression analyses were performed to identify which parameters best correlated with myocardial performance (cardiac index: mL·min(-1)·g(-1)). Functional parameters exhibited excellent correlation with myocardial performance and demonstrated high sensitivity and specificity for identifying hearts at risk of poor post-transplant function (ejection fraction: R(2) = 0.80, sensitivity = 1.00, specificity = 0.85; stroke work: R(2) = 0.76, sensitivity = 1.00, specificity = 0.77; minimum dP/dt: R(2) = 0.74, sensitivity = 1.00, specificity = 0.54; tau: R(2) = 0.51, sensitivity = 1.00, specificity = 0.92), whereas metabolic parameters were limited in their ability to predict myocardial performance (oxygen consumption: R(2) = 0.28; coronary vascular resistance: R(2) = 0.20; lactate concentration: R(2) = 0.02). We concluded that evaluation of functional parameters provides the best assessment of myocardial performance during EVHP, which highlights the need for an EVHP device capable of assessing the donor heart in a physiologic working mode.
authors: a Cardiac Surgery, St. Boniface Hospital, University of Manitoba, 409 Taché Avenue, Winnipeg, MB R2H 2A6, Canada.|b Institute of Cardiovascular Sciences, St. Boniface Research Center, 351 Taché Avenue, Winnipeg, MB R2H 2A6, Canada.
authors: Christopher W
authors: CW
authors: White
authors: b Institute of Cardiovascular Sciences, St. Boniface Research Center, 351 Taché Avenue, Winnipeg, MB R2H 2A6, Canada.
authors: Emma
authors: E
authors: Ambrose
authors: b Institute of Cardiovascular Sciences, St. Boniface Research Center, 351 Taché Avenue, Winnipeg, MB R2H 2A6, Canada.
authors: Alison
authors: A
authors: Müller
authors: b Institute of Cardiovascular Sciences, St. Boniface Research Center, 351 Taché Avenue, Winnipeg, MB R2H 2A6, Canada.
authors: Yun
authors: Y
authors: Li
authors: b Institute of Cardiovascular Sciences, St. Boniface Research Center, 351 Taché Avenue, Winnipeg, MB R2H 2A6, Canada.
authors: Hoa
authors: H
authors: Le
authors: a Cardiac Surgery, St. Boniface Hospital, University of Manitoba, 409 Taché Avenue, Winnipeg, MB R2H 2A6, Canada.
authors: Brett
authors: B
authors: Hiebert
authors: a Cardiac Surgery, St. Boniface Hospital, University of Manitoba, 409 Taché Avenue, Winnipeg, MB R2H 2A6, Canada.|b Institute of Cardiovascular Sciences, St. Boniface Research Center, 351 Taché Avenue, Winnipeg, MB R2H 2A6, Canada.|d National Research Council Institute for Biodiagnostics, 435 Ellice Avenue, Winnipeg, MB R3B 1Y6, Canada.
authors: Rakesh
authors: R
authors: Arora
authors: c Anesthesia and Perioperative Medicine, St. Boniface Hospital, University of Manitoba, 409 Taché Avenue, Winnipeg, MB R2H 2A6, Canada.
authors: Trevor W
authors: TW
authors: Lee
authors: b Institute of Cardiovascular Sciences, St. Boniface Research Center, 351 Taché Avenue, Winnipeg, MB R2H 2A6, Canada.
authors: Ian
authors: I
authors: Dixon
authors: d National Research Council Institute for Biodiagnostics, 435 Ellice Avenue, Winnipeg, MB R3B 1Y6, Canada.
authors: Ganghong
authors: G
authors: Tian
authors: e Cardiac Surgery, Mazankowski Alberta Heart Institute, University of Alberta Hospital, 2D4.34 WMC, 8440-112 Street, Edmonton, AB T6G 2B7, Canada.
authors: Jayan
authors: J
authors: Nagendran
authors: b Institute of Cardiovascular Sciences, St. Boniface Research Center, 351 Taché Avenue, Winnipeg, MB R2H 2A6, Canada.
authors: Larry
authors: L
authors: Hryshko
authors: a Cardiac Surgery, St. Boniface Hospital, University of Manitoba, 409 Taché Avenue, Winnipeg, MB R2H 2A6, Canada.|b Institute of Cardiovascular Sciences, St. Boniface Research Center, 351 Taché Avenue, Winnipeg, MB R2H 2A6, Canada.|d National Research Council Institute for Biodiagnostics, 435 Ellice Avenue, Winnipeg, MB R3B 1Y6, Canada.|e Cardiac Surgery, Mazankowski Alberta Heart Institute, University of Alberta Hospital, 2D4.34 WMC, 8440-112 Street, Edmonton, AB T6G 2B7, Canada.
authors: Darren
authors: D
authors: Freed
mesh_terms: D000818:Animals; D004867:Equipment Design; D005260:Female; D006321:Heart / Q000502:physiology*; D016027:Heart Transplantation; D008954:Models, Biological; D009926:Organ Preservation / Q000295:instrumentation / Q000379:methods*; D019188:Organ Preservation Solutions; D010101:Oxygen Consumption / Q000502:physiology; D010477:Perfusion / Q000295:instrumentation / Q000379:methods*; D034421:Sus scrofa; D014022:Tissue Survival / Q000502:physiology*; D020858:Tissue and Organ Harvesting / Q000295:instrumentation / Q000379:methods*
chemical_list: D019188:Organ Preservation Solutions
keywords: consommation d’oxygène; ex vivo heart perfusion; functional assessment; greffe cardiaque; heart transplant; lactate metabolism; machine de perfusion; machine perfusion; métabolisme de l’acide lactique; organ evaluation; organ preservation; oxygen consumption; perfusion cardiaque ex vivo; préservation des organes; évaluation des organes; évaluation fonctionnelle