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Novel Percutaneous Approach for Deployment of 3D Printed Coronary Stenosis Implants in Swine Models of Ischemic Heart Disease
Published on: February 18, 2020
Coronary computed tomographic angiographic imaging of cardiac allograft preserved in Paragonix SherpaPak Cardiac
Marian Urban1, Brian D Lowes2, Stanley J Radio3
1Department of Surgery, Division of Cardiothoracic Surgery, University of Nebraska Medical Center, Omaha, Nebraska.
Insights
Donation after circulatory death heart transplantation can be improved by using coronary computed tomographic angiography on nonbeating allografts. This novel approach allows for ex-situ imaging and evaluation of coronary artery disease in donor hearts.
Area of Science:
- Cardiovascular Surgery
- Transplantation Medicine
- Medical Imaging
Background:
- Donation after circulatory death (DCD) heart transplantation expands the donor pool but faces challenges in organ quality evaluation due to logistical and ethical constraints of antemortem testing.
- Assessing coronary artery disease is crucial for accepting DCD heart allografts, yet current methods are limited in the DCD setting.
- A reliable method for evaluating donor heart coronary arteries ex-situ is needed to increase DCD heart transplant utilization.
Purpose of the Study:
- To present a novel approach for evaluating coronary arteries in a DCD cardiac allograft.
- To demonstrate the feasibility and quality of ex-situ coronary computed tomographic angiography in a nonbeating DCD heart allograft.
Main Methods:
- Coronary computed tomographic angiography was performed on a nonbeating cardiac allograft preserved in a SherpaPak Cardiac Transport System.
- Ex-situ imaging allowed for three-dimensional reconstruction and quantification of coronary lesions.
Main Results:
- Ex-situ coronary computed tomographic angiography of the nonbeating cardiac allograft was technically feasible.
- The imaging produced good quality images, enabling detailed analysis of coronary arteries.
- Three-dimensional reconstruction and quantification of coronary lesions were successfully achieved.
Conclusions:
- Ex-situ coronary computed tomographic angiography is a viable method for assessing coronary arteries in DCD cardiac allografts.
- This technique can overcome limitations of traditional evaluation methods, potentially increasing the use of DCD hearts.
- This novel approach facilitates essential donor organ quality evaluation for DCD heart transplantation.
Abstract:
Donation after circulatory death (DCD) heart transplantation is emerging as an alternative pathway to traditional donation after brain death (DBD) to expand the heart donor pool. Greater adoption of DCD heart allografts is hampered by the logistical and ethical constraints to perform invasive antemortem testing, thus limiting the capacity for the standard donor organ quality evaluation. Identification of the absence of coronary artery disease in patients at risk is an essential prerequisite for organ acceptance by an implant institution. This case presents a novel approach to the examination of coronary arteries in a cardiac allograft. We demonstrated that the coronary computed tomographic angiographic imaging of an ex-situ nonbeating cardiac allograft preserved after recovery in SherpaPak Cardiac Transport System is technically feasible. The images are of good quality and allow for three-dimensional reconstruction as well as quantification of coronary lesions.
