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Large-Animal Model of Donation after Circulatory Death and Normothermic Regional Perfusion for Cardiac Assessment
Published on: May 10, 2022
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Characterizing cardiac donation after circulatory death: implications for perfusion preservation
Sarah M Brant1, Michael L Cobert1, LaShondra M West1
1Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
The Annals of Thoracic Surgery
|December 3, 2014
Summary
Machine perfusion preservation effectively recovers Donation after Circulatory Determination of Death (DCDD) donor hearts, showing improved function compared to static storage. This method offers a promising approach for utilizing DCDD hearts in cardiac transplantation.
Area of Science:
- Cardiology
- Transplantation Surgery
- Organ Preservation
Background:
- Donation after Circulatory Determination of Death (DCDD) protocols vary, impacting donor heart ischemic times.
- DCDD hearts are underutilized for transplantation due to preservation challenges.
- Machine perfusion shows potential for improving DCDD heart viability.
Purpose of the Study:
- To investigate the agonal phase in DCDD donors.
- To evaluate retrograde machine perfusion for preserving DCDD donor hearts.
- To assess the functional recovery of DCDD hearts using a large animal model.
Main Methods:
- Ten canines underwent anesthesia and ventilation withdrawal.
- Key time points of circulatory arrest (loss of pulse, pressure, asystole) were recorded.
- Hearts were preserved via retrograde machine perfusion or static cold storage for 4 hours, then transplanted and reperfused for 6 hours.
Main Results:
- Agonal phase parameters were consistent across groups.
- Electrical silence varied (11–43 minutes).
- Machine-perfused hearts demonstrated significantly higher myocardial function (preload recruitable stroke work) and better separation from cardiopulmonary bypass compared to static-preserved hearts.
Conclusions:
- DCDD protocols significantly influence donor heart ischemic times.
- Machine perfusion preservation offers superior and more consistent recovery of DCDD donor hearts than static storage.
- This technique enhances the potential for DCDD heart transplantation.
