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Preload-recruitable stroke work relationships and diastolic dysfunction in the brain-dead organ donor
H B Bittner1, E P Chen, D Craig
1Department of General and Cardiothoracic Surgery, Duke University Medical Center, Durham, NC 27710, USA.
Circulation
|November 1, 1996
Summary
Brain death (BD) significantly impairs cardiac function. This study shows BD causes loss of systolic and diastolic function in the heart, potentially leading to graft failure after transplantation.
Area of Science:
- Cardiology
- Transplantation Immunology
- Physiology
Background:
- Acute graft failure is a major complication in cardiac transplantation.
- Myocardial changes during brain death (BD) may contribute to graft failure.
- Investigating cardiac function changes post-BD is crucial.
Purpose of the Study:
- To investigate biventricular systolic and diastolic function changes after brain death (BD).
- To utilize a validated canine model to assess cardiac mechanics post-BD.
Main Methods:
- Instrumentation of canine hearts with micromanometers, flow probes, and dimension transducers.
- Measurement of left and right ventricular (LV/RV) volumes and dimensions.
- Analysis of systolic function using preload-independent recruitable systolic work (PRSW) and diastolic mechanics via pressure-dimension relationships.
Main Results:
- Brain death induced the Cushing phenomenon, hyperdynamic response, and diabetes insipidus.
- Significant deterioration in biventricular systolic function (PRSW) was observed 6-7 hours post-BD.
- Decreased ventricular chamber compliance during diastole was indicated by altered LV/RV pressure-dimension relationships.
Conclusions:
- Brain death causes significant loss of both systolic and diastolic biventricular function in heart-beating cadavers.
- These functional deficits may contribute to early postoperative cardiac graft failure.
- Findings may inform donor-recipient matching to improve transplant outcomes.