title: Cold Crystalloid Perfusion Provides Cardiac Preservation Superior to Cold Storage for Donation After Circulatory Death.
abstract: BACKGROUND
  We previously showed that donation after circulatory death (DCD) canine hearts can be resuscitated if perfused with warm blood. However, clinical application of this technique is complex and difficult. We have developed a simplified system of cold crystalloid perfusion and compared it with standard cold storage for DCD heart preservation.
  
  
  METHODS
  Anesthetized greyhounds underwent 30 minutes DCD by withdrawal of ventilation followed by assignment to either 4 hours of perfusion (n = 6) or cold storage (n = 7). Nonpreserved hearts (n = 5) served as a normal reference group. Perfusion hearts were reperfused with a protective solution then perfused for 4 hours with a novel oxygenated, nutrient-containing solution at 20 mL/min at 4°C to 10°C. Cold storage hearts were flushed with St Thomas' cardioplegic solution and stored in ice. After preservation, the recovery of the hearts was assessed on a blood-perfused working heart rig.
  
  
  RESULTS
  During preservation, perfusion hearts consumed oxygen (0.09 ± 0.01 mL/100 g per minute) and showed decreasing lactate production in the perfusate (initial: 0.031 ± 0.004 vs final: 0.007 ± 0.002 mmol/min; P = 0.001). After preservation, compared to cold storage hearts, perfusion hearts had higher cardiac output (P = 0.004), LV dP/dt max (P = 0.003) and myocardial oxygen efficiency (P = 0.01), with lower blood perfusate lactate (P = 0.007). Hemodynamic values of perfused hearts reached 60% or more those in the normal reference group.
  
  
  CONCLUSIONS
  Continuous cold crystalloid perfusion in a canine model of DCD: (1) facilitates aerobic metabolism and resuscitates the DCD heart, (2) provides functional and metabolic recovery superior to cold storage, (3) shows promise for improved clinical preservation of DCD and marginal donor hearts.
authors.affiliation: 1 Department of Cardiothoracic Surgery, Cardiac Surgical Research Unit, Alfred Hospital and the Department of Surgery, Monash University, Melbourne, Australia.
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Choong
authors.forename: Ruchong
authors.initials: R
authors.lastname: Ou
authors.forename: Yi Wee
authors.initials: YW
authors.lastname: Lim
authors.forename: Franklin L
authors.initials: FL
authors.lastname: Rosenfeldt
mesh_terms: D000818:Animals; D002302:Cardiac Output / Q000187:drug effects; D003080:Cold Temperature; D004285:Dogs; D004734:Energy Metabolism / Q000187:drug effects; D016027:Heart Transplantation / Q000379:methods*; D019344:Lactic Acid / Q000378:metabolism; D009206:Myocardium / Q000378:metabolism / Q000473:pathology; D009926:Organ Preservation / Q000379:methods*; D010100:Oxygen / Q000378:metabolism; D010477:Perfusion / Q000379:methods*; D017680:Potassium Compounds / Q000494:pharmacology*; D020127:Recovery of Function; D013997:Time Factors; D020858:Tissue and Organ Harvesting
chemical_list: D017680:Potassium Compounds; C018369:potassium cardioplegic solution; D019344:Lactic Acid; D010100:Oxygen