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Electrical graft assessment of machine-perfused hearts donated after circulatory death
Jorik H Amesz1,2, Mark F A Bierhuizen1,2, Sanne J J Langmuur1,3
1Translational Cardiothoracic Surgery Research Lab, Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
Insights
High-resolution cardiac mapping offers a new way to assess the electrical function of donor hearts during normothermic ex situ heart perfusion (ESHP). This technique may help identify myocardial injury in hearts donated after circulatory death (DCD).
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Engineering
Background:
- Normothermic ex situ heart perfusion (ESHP) expands the donor heart pool from circulatory death (DCD) donors.
- Lactate trends during ESHP are insufficient for assessing donor heart function.
- Assessing electrical function of DCD hearts during ESHP is crucial for transplantation success.
Purpose of the Study:
- To evaluate the clinical use of high-resolution cardiac mapping for assessing electrical function in human DCD hearts on ESHP.
- To determine if low-voltage areas identified by mapping correlate with myocardial injury.
- To establish cardiac mapping as a potential diagnostic tool for marginal donor hearts.
Main Methods:
- Ten DCD hearts were procured and perfused using normothermic ESHP.
- High-resolution epicardial mapping with a 192-electrode array was performed on the left and right ventricles.
- Analysis included unipolar potential voltages, slopes, conduction velocity, low-voltage potentials, and conduction block.
Main Results:
- Cardiac mapping was safely and feasibly performed on ten DCD hearts prior to transplantation.
- Median potential voltages for the left and right ventricles were 15.7 mV and 11.3 mV, respectively.
- Minimal low-voltage potentials were observed in transplanted hearts; one rejected heart showed no difference in electrical function.
Conclusions:
- High-resolution electrical mapping is a feasible and potentially valuable tool for assessing DCD heart function during ESHP.
- This technique may aid in evaluating marginal donor hearts and identifying myocardial injury.
- Cardiac mapping provides additional diagnostic information beyond lactate trends for ESHP assessment.
Background:
Normothermic ex situ heart perfusion (ESHP) has increased the donor pool with hearts donated after circulatory death (DCD), but functional assessment during ESHP using lactate trends is suboptimal. This study presents the clinical use of high-resolution cardiac mapping to assess electrical function of human DCD hearts on ESHP, where low-voltage-areas might be indicative of myocardial injury.
Methods:
Hearts were procured following circulatory arrest of the donor and restarted on normothermic ESHP. DCD hearts were transported to the recipient hospital and lactate concentrations were regularly measured in the perfusate. High-resolution epicardial mapping of the left (LV) and right ventricle (RV) was performed with a 192-electrode array during normothermic ESHP prior to transplantation. Unipolar potential voltages and slopes, conduction velocity and the amount of low-voltage potentials and conduction block were calculated from these recordings.
Results:
Electrical mapping was performed on ten DCD hearts transported on ESHP with sequential cardiac transplantation, showing safety and feasibility of the technique. Median potential voltage of the LV and RV was 15.7 mV (14.0-17.4 mV) and 11.3 mV (8.3-11.9 mV) respectively, and low-voltage potentials were minimally present. In comparison, the electrical function of one rejected heart with increasing lactate trend did not differ from the transplanted hearts.
Conclusions:
High-resolution electrical mapping of DCD hearts on ESHP may serve as novel additional diagnostic tool for assessing graft function, especially in marginal donors.
