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Updated: Aug 21, 2025
Pre-clinical Model of Cardiac Donation after Circulatory Death
Published on: August 2, 2019
Prediction Model for Contractile Function of Circulatory Death Donor Hearts Based on Microvascular Flow Shifts During
Lars Saemann1,2, Matthias Kohl3, Gábor Veres1,2
1Department of Cardiac Surgery, University Hospital Halle (Saale) University of Halle Halle (Saale) Germany.
Insights
Machine perfusion (MP) of circulatory death donor (DCD) hearts using Custodiol-N solution shows promise. Myocardial microvascular flow shifts measured by Laser Doppler Flow (LDF) technology can predict DCD heart contractility after preservation.
Area of Science:
- Cardiovascular Surgery
- Organ Transplantation
- Cardiology
Background:
- Circulatory death donor (DCD) hearts are typically preserved using machine perfusion (MP) with donor blood.
- Current methods for assessing DCD heart function post-preservation, such as lactate levels and visual inspection, are insufficient.
- Machine perfusion with Custodiol-N solution has demonstrated superiority over blood perfusion for maintaining porcine DCD hearts.
Purpose of the Study:
- To develop a method for predicting the contractility of DCD hearts after cardioplegic MP.
- To test the hypothesis that microvascular flow shifts during MP with Custodiol-N predict heart contractility.
Main Methods:
- Porcine DCD hearts were preserved using hypothermic, oxygenated Custodiol-N solution during MP for 4 hours.
- Myocardial microvascular flow was monitored using Laser Doppler Flow (LDF) technology.
- Hearts were subsequently reperfused with blood for 2 hours, with left ventricular contractility assessed at 30 and 120 minutes.
Main Results:
- Novel parameters derived from LDF shifts were computed to create bivariate prediction models.
- Prediction models based on LDF shifts achieved high R-squared values for end-systolic pressure, maximal slope of pressure increment, and maximal slope of pressure decrement.
- Lactate levels remained constant and were not suitable for predicting contractility.
Conclusions:
- The shift in myocardial microvascular flow, as measured by LDF during MP with Custodiol-N, can effectively predict the contractility of DCD hearts.
- This LDF-based prediction method offers a promising advancement over current assessment techniques for DCD hearts preserved with cardioplegic solutions.
Abstract:
Background Hearts procured from circulatory death donors (DCD) are predominantly maintained by machine perfusion (MP) with normothermic donor blood. Currently, DCD heart function is evaluated by lactate and visual inspection. We have shown that MP with the cardioplegic, crystalloid Custodiol-N solution is superior to blood perfusion to maintain porcine DCD hearts. However, no method has been developed yet to predict the contractility of DCD hearts after cardioplegic MP. We hypothesize that the shift of microvascular flow during continuous MP with a cardioplegic preservation solution predicts the contractility of DCD hearts. Methods and Results In a pig model, DCD hearts were harvested and maintained by MP with hypothermic, oxygenated Custodiol-N for 4 hours while myocardial microvascular flow was measured by Laser Doppler Flow (LDF) technology. Subsequently, hearts were perfused with blood for 2 hours, and left ventricular contractility was measured after 30 and 120 minutes. Various novel parameters which represent the LDF shift were computed. We used 2 combined LDF shift parameters to identify bivariate prediction models. Using the new prediction models based on LDF shifts, highest r2 for end-systolic pressure was 0.77 (P=0.027), for maximal slope of pressure increment was 0.73 (P=0.037), and for maximal slope of pressure decrement was 0.75 (P=0.032) after 30 minutes of reperfusion. After 120 minutes of reperfusion, highest r2 for end-systolic pressure was 0.81 (P=0.016), for maximal slope of pressure increment was 0.90 (P=0.004), and for maximal slope of pressure decrement was 0.58 (P=0.115). Identical prediction models were identified for maximal slope of pressure increment and for maximal slope of pressure decrement at both time points. Lactate remained constant and therefore was unsuitable for prediction. Conclusions Contractility of DCD hearts after continuous MP with a cardioplegic preservation solution can be predicted by the shift of LDF during MP.
