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Concentrations of catecholamines in transplanted hearts after extracorporeal perfusion and cold storage
J Babin-Ebell1, R E Silber, F Kobelt
1Clinic of Cardiac and Thoracic Surgery, University of Würzburg, Germany.
Insights
Extracorporeal heart perfusion did not improve heart function compared to cold storage after 9 hours. Excessive catecholamine liberation was not found to be the cause of heart failure in this study.
Area of Science:
- Cardiology
- Transplantation Medicine
- Organ Preservation
Background:
- Investigating methods to improve heart function after preservation is crucial for transplantation success.
- Previous studies suggested potential benefits of extracorporeal perfusion for extended periods (24-72h).
- Concerns exist regarding catecholamine release during ischemia and its impact on heart function post-perfusion.
Purpose of the Study:
- To investigate pathological increases in noradrenaline and its metabolite dihydroxyphenylglycol (DOPEG) during 5-hour extracorporeal heart perfusion in pigs.
- To compare catecholamine levels and metabolic markers between continuously perfused hearts and those stored at 4°C.
- To determine if excessive catecholamine liberation contributes to heart failure after cold storage or perfusion.
Main Methods:
- Utilized a porcine model for continuous extracorporeal heart perfusion for 5 hours.
- Compared venoarterial differences of noradrenaline and DOPEG between perfused and cold-stored hearts (4°C).
- Monitored lactate and pyruvate concentrations and their ratio to assess metabolic status during and after perfusion.
Main Results:
- No significant difference in venoarterial noradrenaline and DOPEG levels between the two groups.
- Lactate and pyruvate concentrations decreased significantly after 3 hours of hypothermic perfusion.
- The lactate/pyruvate ratio increased significantly only after the cessation of extracorporeal circulation, reaching 40-65.
Conclusions:
- Excessive liberation of catecholamines is not the cause of heart failure following cold storage or extracorporeal perfusion in this model.
- Metabolic changes, indicated by the lactate/pyruvate ratio, suggest potential issues arising post-perfusion rather than during.
- Further research is needed to elucidate the mechanisms behind impaired heart function after prolonged preservation techniques.
Abstract:
Using different perfusion regimes and orthograde implantation, some investigators have found sufficient heart function after extracorporeal perfusion of hearts for 24 and even 72 h. However, we found no significant improvement of perfused hearts compared to cold stored hearts after a 9-h extracorporeal period. A possible explanation for this finding could be the excessive liberation of catecholamines during ischemia, as has been demonstrated in isolated perfused hearts. Therefore, the aim of this study was to investigate whether concentrations of noradrenaline and dihydroxyphenylglycol (DOPEG)--a noradrenaline metabolite-increased pathologically during continuous extracorporeal heart perfusion for 5 h in pigs, in comparison to hearts stored at 4 degrees C. The venoarterial differences in noradrenaline and DOPEG were not significantly different in the two groups. Concentrations of lactate and pyruvate decreased substantially after 3-h hypothermic perfusion. The lactate/pyruvate ratio remained at a value of 25-35. Only after the end of the extracorporeal circulation did this ratio reach a value of 40-65. In our model, these findings demonstrate that the excessive liberation of catecholamines is not a reason for heart failure after cold storage or perfusion.