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Updated: May 27, 2025
Normothermic Ex Situ Heart Perfusion in Working Mode: Assessment of Cardiac Function and Metabolism
Published on: January 12, 2019
A Smart Computational Tool for Personalized Coronary Blood Flow Settings During Normothermic Ex Situ Heart Perfusion
Jorik H Amesz1, Niki L Lupgens1, Dirk J Duncker2
1From the Translational Cardiothoracic Surgery Research Lab, Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
Insights
A new tool calculates donor heart coronary blood flow (CBF) during ex situ heart perfusion (ESHP), preventing edema by optimizing oxygen delivery. This personalized approach aids in assessing heart quality before transplantation.
Area of Science:
- Cardiovascular Surgery
- Organ Transplantation
- Biomedical Engineering
Background:
- Myocardial edema is a significant issue during ex situ heart perfusion (ESHP), leading to reduced heart function.
- High coronary blood flow (CBF) during ESHP is implicated in myocardial edema formation.
Purpose of the Study:
- To develop a novel tool for calculating CBF during ESHP.
- To personalize perfusion strategies by balancing oxygen supply and demand.
- To aid in the qualitative assessment of donor hearts.
Main Methods:
- A new tool was created to calculate CBF based on donor and perfusate characteristics.
- The tool continuously monitors myocardial oxygen consumption (MVO 2 ) and delivery.
- It calculates MVO 2 , partial pressure of oxygen difference (ΔPO 2 ), and coronary vascular resistance.
Main Results:
- The tool enables calculation of personalized CBF, potentially reducing it while ensuring adequate oxygenation.
- It facilitates continuous monitoring and assessment of donor heart status during ESHP.
- This approach helps prevent excess perfusion and associated myocardial edema.
Conclusions:
- The novel tool offers a personalized approach to manage CBF during ESHP.
- Optimizing CBF can mitigate myocardial edema and improve donor heart function.
- The tool enhances donor heart assessment before transplantation.
Abstract:
Myocardial edema significantly develops during current subnormothermic ex situ heart perfusion (ESHP) procedures, resulting in myocardial function decline during prolonged perfusion. A relatively high coronary blood flow (CBF) during ESHP is thought to be responsible for this high degree of myocardial edema formation. In this study, we present a novel tool to calculate CBF based on individual donor (sex and body weight) and perfusate (hemoglobin concentration, oxygen saturation, partial pressure of oxygen [PO 2 ]) characteristics. The tool continuously evaluates the balance between myocardial oxygen consumption (MVO 2 ) and delivery to facilitate adequate and preventing excess perfusion. Taking this personalized approach, the CBF can potentially be lowered while still providing sufficient oxygen to the donor heart. Furthermore, the tool automatically calculates MVO 2 , ΔPO 2 , and coronary vascular resistance during ESHP, which aids in the qualitative assessment of the heart before transplantation.
