Related Experiment Video
Updated: Apr 4, 2026
Functional Assessment of the Donor Heart During Ex Situ Perfusion: Insights from Pressure-Volume Loops and Surface Echocardiography
Published on: October 11, 2022
Assessment of donor heart viability during ex vivo heart perfusion
Christopher W White1,2, Emma Ambrose2, Alison Müller2
1a Cardiac Surgery, St. Boniface Hospital, University of Manitoba, 409 Taché Avenue, Winnipeg, MB R2H 2A6, Canada.
Insights
Functional parameters, not metabolic ones, best predict heart performance during ex vivo heart perfusion (EVHP). This finding is crucial for assessing donor heart viability and expanding the organ donor pool for transplantation.
Area of Science:
- Cardiology
- Transplantation Medicine
- Physiology
Background:
- Ex vivo heart perfusion (EVHP) offers potential to resuscitate discarded donor hearts, expanding the donor pool.
- A reliable method to assess organ viability before transplantation during EVHP is currently lacking.
Purpose of the Study:
- To identify metabolic and functional parameters that accurately predict myocardial performance during EVHP.
- To evaluate the predictive capability of these parameters across a range of organ functions.
Main Methods:
- Hearts from normal and donation after circulatory death pigs were perfused ex vivo.
- Functional parameters (e.g., ejection fraction, stroke work) and metabolic parameters (e.g., oxygen consumption, lactate) were measured.
- Linear regression analysis correlated parameters with myocardial performance (cardiac index).
Main Results:
- Functional parameters demonstrated strong correlations with myocardial performance (ejection fraction R(2)=0.80, stroke work R(2)=0.76).
- Functional parameters showed high sensitivity and specificity in identifying hearts at risk of poor post-transplant function.
- Metabolic parameters had limited predictive ability (oxygen consumption R(2)=0.28, lactate R(2)=0.02).
Conclusions:
- Functional parameters are superior to metabolic parameters for assessing myocardial performance during EVHP.
- This highlights the need for EVHP devices that can evaluate donor hearts in a physiologic working state.
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.
