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Published on: January 12, 2019
Investigating Cardiac Temperature During Heart Transplantation Using the Static Cold Storage Paradigm
Juan Rodriguez Paez1, Ruth E White1, Kaitlyn Dunn1
1Department of Biomedical Engineering, Florida Institute of Technology, Melbourne, FL.
Insights
Understanding heart transplant (HTx) temperature changes is key. This study quantifies rapid, uneven cooling and warming during HTx stages, revealing critical insights for improving organ viability.
Area of Science:
- Biomedical Engineering
- Cardiovascular Research
- Organ Transplantation Science
Background:
- Static cold storage is fundamental to heart transplantation (HTx).
- Temperature dynamics within the heart during HTx remain largely uncharacterized.
- This study addresses the knowledge gap in thermal profiles throughout the HTx process.
Purpose of the Study:
- To quantify the duration of heart cooling and warming during HTx.
- To characterize the temperature distribution within the heart at each HTx stage.
- To provide critical data for optimizing HTx procedures and organ preservation.
Main Methods:
- Utilized high-fidelity computational time-varying biothermal modeling.
- Employed an anatomical human heart model.
- Simulated 5 interdependent stages of the HTx process, from cardioplegia to reperfusion.
Main Results:
- Hearts undergo rapid cooling to below 10°C within 15 minutes, with a maximum cooling rate of 5°C/min.
- Hearts experience extended periods below 2°C during static cold storage.
- Warming to body temperature occurs rapidly (within 10 minutes) upon reperfusion, with heterogeneous rates between the left and right sides (2°C/min and 4°C/min, respectively).
- Significant temperature heterogeneity exists, with the right side warming nearly twice as fast as the left.
Conclusions:
- This study provides the first detailed temperature distribution and evolution data for each stage of HTx.
- The rapid and heterogeneous temperature changes identified are critical for enhancing heart graft viability.
- Quantifying these thermal dynamics can lead to optimized HTx protocols and improved patient outcomes.
Background:
Static cold storage is a mainstay of the heart transplantation (HTx) process. However, the temperature distribution within the organ at each stage of HTx is unknown. In this study, we aimed to quantify how long it took for the heart to warm up and cool down and the nature of temperature distribution with the organ at each stage of HTx.
Methods:
We used high-fidelity computational time-varying biothermal modeling on an anatomical human heart model to model the HTx process in 5 interdependent stages, including cardioplegia, back-table preparation, static cold storage ice box storage and transport, back-table preparation at the recipient institution and warm-up within the recipient body before cross-clamp release.
Results:
Results indicate that the heart experiences roller-coaster-like temperature changes in stage, including rapid cool down from body temperature to <10 °C within 15 min in stage 1 with a maximum cooling rate of 5 °C/min. This was followed by cooling and extended duration of temperatures <2 °C in the ice box and rapid warming up to body temperature within 10 min at rates of 2 °C/min and 4 °C/min for the left and right sides, respectively, during implantation. Temperature distribution throughout the heart was heterogeneous, with right-sided temperature change occurring nearly 2× faster than on the left side.
Conclusions:
We present, for the first time, detailed temperature distributions and evolution at each stage of HTx. Quantification of the rapid and heterogeneous temperature changes is crucial to optimize HTx and improve organ viability.
