Related Experiment Video
Updated: Jun 18, 2025
Author Spotlight: Innovative Technique for Coronary Angiography in Marginal Donors
Published on: July 12, 2024
Coronary Angiography During Ex-Situ Heart Perfusion in a Porcine Model
Ali Akamkam1, Vincenzo Palermo2, Tiphaine Legrand3
1Department of Cardiovascular Surgery, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph; Laboratory of Preclinical Research, Department of Research and Innovation, Groupe Hospitalier Paris Saint Joseph; Inserm UMR S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph.
Insights
Coronary angiography during normothermic ex-situ heart perfusion (NESP) allows for effective screening of extended criteria donor hearts for coronary artery disease, ensuring graft viability and potentially increasing organ availability for heart transplantation.
Area of Science:
- Cardiology
- Transplantation Surgery
- Medical Imaging
Background:
- Heart transplantation is the primary treatment for end-stage heart failure.
- Organ shortages necessitate the use of extended criteria donors (ECD).
- Coronary artery disease screening in ECD hearts is inconsistent, leading to potential graft failure or organ rejection.
Purpose of the Study:
- To establish a protocol for coronary angiography during normothermic ex-situ heart perfusion (NESP).
- To assess the feasibility and reproducibility of NESP for imaging ECD hearts.
- To evaluate the impact of NESP coronary angiography on myocardial viability.
Main Methods:
- Development of a protocol detailing material requirements and optimal imaging views for NESP coronary angiography.
- Systematic imaging of the coronary arteries, including specific views for the right coronary artery, left anterior descending artery, and circumflex artery.
- Monitoring of myocardial viability through continuous lactate extraction measurements post-angiography.
Main Results:
- Reproducible angiographic views were achieved for all major coronary arteries.
- Continuous lactate extraction indicated preserved myocardial viability after NESP coronary angiography (median 1.10 mmol/L at 2 hours).
- The median contrast agent volume used was 48 mL, demonstrating efficient imaging.
Conclusions:
- Coronary angiography during NESP is a reproducible method for assessing ECD hearts.
- This technique can enhance the utilization of ECDs by screening for coronary artery disease.
- NESP coronary angiography does not compromise myocardial viability, supporting its use in heart transplantation protocols.
Abstract:
Heart transplantation is the gold standard treatment for advanced heart failure. The procurement of extended criteria donors (ECD) increases due to the current organ shortage. Coronary angiography is recommended in ECD at risk for coronary artery disease but is not systematically performed. These hearts are, therefore, either declined for transplant or procured without screening for coronary artery disease. Coronary angiography during normothermic ex-situ heart perfusion (NESP) could be an interesting approach to enhance the rate of ECD procurement and to reduce the risk of primary graft failure in the absence of coronary angiography in ECD. The present protocol aims to provide material details along with optimal imaging views for coronary angiography during NESP. Reproducible angiographic views were observed, including one dedicated to the right coronary artery, two for the left anterior descending artery, two for the circumflex artery, and a spider view. Continuous lactate extraction was observed in all procedures with a final median concentration of 1.10 mmol/L (0.61-1.75 mmol/L) two hours after coronary angiography, consistent with myocardial viability. The median contrast agent volume used for ex-situ imaging of the isolated perfused heart was 48 mL (38-108 mL). This protocol was reproducible for coronary artery imaging and did not impair myocardial viability during NESP.
