title: Physiologic Changes in the Heart Following Cessation of Mechanical Ventilation in a Porcine Model of Donation After Circulatory Death: Implications for Cardiac Transplantation.
abstract: Hearts donated following circulatory death (DCD) may represent an additional source of organs for transplantation; however, the impact of donor extubation on the DCD heart has not been well characterized. We sought to describe the physiologic changes that occur following withdrawal of life-sustaining therapy (WLST) in a porcine model of DCD. Physiologic changes were monitored continuously for 20 min following WLST. Ventricular pressure, volume, and function were recorded using a conductance catheter placed into the right (N = 8) and left (N = 8) ventricles, and using magnetic resonance imaging (MRI, N = 3). Hypoxic pulmonary vasoconstriction occurred following WLST, and was associated with distension of the right ventricle (RV) and reduced cardiac output. A 120-fold increase in epinephrine was subsequently observed that produced a transient hyperdynamic phase; however, progressive RV distension developed during this time. Circulatory arrest occurred 7.6±0.3 min following WLST, at which time MRI demonstrated an 18±7% increase in RV volume and a 12±9% decrease in left ventricular volume compared to baseline. We conclude that hypoxic pulmonary vasoconstriction and a profound catecholamine surge occur following WLST that result in distension of the RV. These changes have important implications on the resuscitation, preservation, and evaluation of DCD hearts prior to transplantation.
authors.affiliation: Cardiac Surgery, University of Manitoba, Winnipeg, Canada.|Institute of Cardiovascular Sciences, St. Boniface Research Center, Winnipeg, Canada.
authors.forename: C W
authors.initials: CW
authors.lastname: White
authors.affiliation: College of Pharmacy, University of Manitoba, Winnipeg, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Lillico
authors.affiliation: Faculty of Medicine, University of Alberta, Edmonton, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Sandha
authors.affiliation: Institute of Cardiovascular Sciences, St. Boniface Research Center, Winnipeg, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Hasanally
authors.affiliation: National Research Council Institute for Biodiagnostics, Winnipeg, Canada.
authors.forename: F
authors.initials: F
authors.lastname: Wang
authors.affiliation: Institute of Cardiovascular Sciences, St. Boniface Research Center, Winnipeg, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Ambrose
authors.affiliation: Department of Physiology, University of Alberta, Edmonton, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Müller
authors.affiliation: College of Pharmacy, University of Manitoba, Winnipeg, Canada.
authors.forename: O
authors.initials: O
authors.lastname: Rachid
authors.affiliation: Institute of Cardiovascular Sciences, St. Boniface Research Center, Winnipeg, Canada.
authors.forename: Y
authors.initials: Y
authors.lastname: Li
authors.affiliation: National Research Council Institute for Biodiagnostics, Winnipeg, Canada.
authors.forename: B
authors.initials: B
authors.lastname: Xiang
authors.affiliation: Institute of Cardiovascular Sciences, St. Boniface Research Center, Winnipeg, Canada.
authors.forename: H
authors.initials: H
authors.lastname: Le
authors.affiliation: Papworth Hospital, Cambridge, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: Messer
authors.affiliation: Papworth Hospital, Cambridge, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: Ali
authors.affiliation: Papworth Hospital, Cambridge, United Kingdom.
authors.forename: S R
authors.initials: SR
authors.lastname: Large
authors.affiliation: Anesthesia and Perioperative Medicine, University of Manitoba, Winnipeg, Canada.
authors.forename: T W
authors.initials: TW
authors.lastname: Lee
authors.affiliation: Institute of Cardiovascular Sciences, St. Boniface Research Center, Winnipeg, Canada.
authors.forename: I M C
authors.initials: IM
authors.lastname: Dixon
authors.affiliation: College of Pharmacy, University of Manitoba, Winnipeg, Canada.
authors.forename: T M
authors.initials: TM
authors.lastname: Lakowski
authors.affiliation: College of Pharmacy, University of Manitoba, Winnipeg, Canada.
authors.forename: K
authors.initials: K
authors.lastname: Simons
authors.affiliation: Cardiac Surgery, University of Manitoba, Winnipeg, Canada.|Institute of Cardiovascular Sciences, St. Boniface Research Center, Winnipeg, Canada.
authors.forename: R C
authors.initials: RC
authors.lastname: Arora
authors.affiliation: National Research Council Institute for Biodiagnostics, Winnipeg, Canada.
authors.forename: G
authors.initials: G
authors.lastname: Tian
authors.affiliation: Cardiac Surgery, University of Alberta, Edmonton, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Nagendran
authors.affiliation: Institute of Cardiovascular Sciences, St. Boniface Research Center, Winnipeg, Canada.
authors.forename: L V
authors.initials: LV
authors.lastname: Hryshko
authors.affiliation: Cardiac Surgery, University of Manitoba, Winnipeg, Canada.|Institute of Cardiovascular Sciences, St. Boniface Research Center, Winnipeg, Canada.|Department of Physiology, University of Alberta, Edmonton, Canada.|Cardiac Surgery, University of Alberta, Edmonton, Canada.|Department of Biomedical Engineering, University of Alberta, Edmonton, Canada.
authors.forename: D H
authors.initials: DH
authors.lastname: Freed
mesh_terms: D000818:Animals; D006321:Heart / Q000503:physiopathology*; D006323:Heart Arrest; D016027:Heart Transplantation; D006352:Heart Ventricles / Q000473:pathology*; D023421:Models, Animal; D012121:Respiration, Artificial / Q000009:adverse effects*; D013552:Swine; D014019:Tissue Donors; D014022:Tissue Survival; D014661:Vasoconstriction
keywords: basic (laboratory) research; cardiology; critical care; donation after circulatory death (DCD); heart transplantation; intensive care management; ischemia reperfusion injury (IRI); organ procurement; organ procurement and allocation; organ transplantation in general; porcine; science