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Optimizing donor heart outcome after prolonged storage with endothelial function analysis and continuous perfusion.

Robert S Poston1, Junyan Gu, Deyanira Prastein

  • 1University of Maryland School of Medicine and Veterans Affairs Medical Center at Baltimore, Division of Cardiac Surgery, Baltimore, Maryland, USA. rposton@smail.umaryland.edu

The Annals of Thoracic Surgery
|October 7, 2004
PubMed
Summary

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Continuous perfusion (CP) offers better heart graft recovery than cold storage, especially for marginal donors. Endothelial function is key to predicting graft viability after 24-hour preservation.

Area of Science:

  • Cardiovascular Surgery
  • Organ Transplantation
  • Preservation Medicine

Background:

  • Minimizing ischemia during organ transport with continuous perfusion (CP) may improve outcomes for marginal donors.
  • Investigated donor heart viability analysis to predict graft recovery after extended preservation.

Purpose of the Study:

  • To evaluate the efficacy of continuous perfusion (CP) versus cold static storage (CS) for 24-hour heart preservation.
  • To determine if donor heart viability analysis, particularly endothelial function, predicts graft recovery.

Main Methods:

  • Dog hearts were preserved using CS (8 or 24 hours) or CP (24 hours) with oxygenated solution.
  • Assessed myocardial function, metabolism, and endothelial function at baseline and post-preservation/reperfusion.

Related Experiment Videos

  • Evaluated edema via weight gain and histology.

    • Main Results:

    • CP demonstrated superior recovery of systolic function (87% vs 65%) and faster lactate consumption compared to CS.
    • Normal endothelial function and CP use were significant predictors of systolic pressure recovery (>75%).
    • CP led to increased edema and impaired diastolic function compared to CS.

    Conclusions:

    • Continuous perfusion supports aerobic metabolism, enhancing systolic function recovery despite longer preservation times.
    • Endothelial function analysis is crucial for identifying donor hearts suitable for 24-hour preservation intervals.