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Cold Crystalloid Perfusion Provides Cardiac Preservation Superior to Cold Storage for Donation After Circulatory
Jonathan W Choong1, Ruchong Ou, Yi Wee Lim
11 Department of Cardiothoracic Surgery, Cardiac Surgical Research Unit, Alfred Hospital and the Department of Surgery, Monash University, Melbourne, Australia.
Insights
Simplified cold perfusion resuscitates donation after circulatory death (DCD) hearts, offering superior recovery compared to cold storage. This method shows promise for improving clinical preservation of DCD and marginal donor hearts.
Area of Science:
- Cardiovascular Research
- Organ Preservation
- Transplantation Medicine
Background:
- Previous work demonstrated warm blood resuscitation of donation after circulatory death (DCD) canine hearts.
- Clinical application of warm blood perfusion is complex.
- A simplified cold crystalloid perfusion system was developed for DCD heart preservation.
Purpose of the Study:
- To compare a novel cold crystalloid perfusion system with standard cold storage for DCD heart preservation.
- To assess the functional and metabolic recovery of DCD hearts after preservation.
Main Methods:
- Greyhounds underwent 30 minutes of DCD followed by 4 hours of either cold perfusion or cold storage.
- Perfusion involved a novel oxygenated, nutrient-containing solution at 4°C to 10°C.
- Cold storage hearts were flushed with cardioplegic solution and stored in ice.
- Heart recovery was assessed using a blood-perfused working heart rig.
Main Results:
- Perfusion hearts consumed oxygen and demonstrated decreasing lactate production during preservation.
- Compared to cold storage, perfusion hearts exhibited higher cardiac output, LV dP/dt max, and myocardial oxygen efficiency.
- Hemodynamic values in perfused hearts reached over 60% of normal reference values.
Conclusions:
- Continuous cold crystalloid perfusion facilitates aerobic metabolism and resuscitates DCD hearts.
- This method provides superior functional and metabolic recovery compared to cold storage.
- The technique shows promise for improved clinical preservation of DCD and marginal donor hearts.
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.
