Extending heart preservation to 24 h with normothermic perfusion
Cold static storage (CSS) for up to 6 h is the gold standard in heart preservation. Although some hearts stored over 6 h have been transplanted, longer CSS times have increased posttransplant morbimortality. Transmedics® Organ Care System (OCS™) is the only FDA-approved commercial system that provid...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2024-04-01
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| Series: | Frontiers in Cardiovascular Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2024.1325169/full |
| _version_ | 1827294218111942656 |
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| author | Brianna L. Spencer Spencer K. Wilhelm Christopher Stephan Kristopher A. Urrea Daniela Pelaez Palacio Robert H. Bartlett Daniel H. Drake Daniel H. Drake Alvaro Rojas-Pena Alvaro Rojas-Pena |
| author_facet | Brianna L. Spencer Spencer K. Wilhelm Christopher Stephan Kristopher A. Urrea Daniela Pelaez Palacio Robert H. Bartlett Daniel H. Drake Daniel H. Drake Alvaro Rojas-Pena Alvaro Rojas-Pena |
| author_sort | Brianna L. Spencer |
| collection | DOAJ |
| description | Cold static storage (CSS) for up to 6 h is the gold standard in heart preservation. Although some hearts stored over 6 h have been transplanted, longer CSS times have increased posttransplant morbimortality. Transmedics® Organ Care System (OCS™) is the only FDA-approved commercial system that provides an alternative to CSS using normothermic ex situ heart perfusion (NEHP) in resting mode with aortic perfusion (Langendorff method). However, it is also limited to 6 h and lacks an objective assessment of cardiac function. Developing a system that can perfuse hearts under NEHP conditions for >24 h can facilitate organ rehabilitation, expansion of the donor pool, and objective functional evaluation. The Extracorporeal Life Support Laboratory at the University of Michigan has worked to prolong NEHP to >24 h with an objective assessment of heart viability during NEHP. An NEHP system was developed for aortic (Langendorff) perfusion using a blood-derived perfusate (leukocyte/thrombocyte-depleted blood). Porcine hearts (n = 42) of different sizes (6–55 kg) were divided into five groups and studied during 24 h NEHP with various interventions in three piglets (small-size) heart groups: (1) Control NEHP without interventions (n = 15); (2) NEHP + plasma exchange (n = 5); (3) NEHP + hemofiltration (n = 10) and two adult-size (juvenile pigs) heart groups (to demonstrate the support of larger hearts); (4) NEHP + hemofiltration (n = 5); and (5) NEHP with intermittent left atrial (iLA) perfusion (n = 7). All hearts with NEHP + interventions (n = 27) were successfully perfused for 24 h, whereas 14 (93.3%) control hearts failed between 10 and 21 h, and 1 control heart (6.6%) lasted 24 h. Hearts in the piglet hemofiltration and plasma exchange groups performed better than those in the control group. The larger hearts in the iLA perfusion group (n = 7) allowed for real-time heart functional assessment and remained stable throughout the 24 h of NEHP. These results demonstrate that heart preservation for 24 h is feasible with our NEHP perfusion technique. Increasing the preservation period beyond 24 h, infection control, and nutritional support all need optimization. This proves the concept that NEHP has the potential to increase the organ pool by (1) considering previously discarded hearts; (2) performing an objective assessment of heart function; (3) increasing the donor/recipient distance; and (4) developing heart-specific perfusion therapies. |
| first_indexed | 2024-04-24T13:53:06Z |
| format | Article |
| id | doaj.art-f13ecef17b1344c080eeebbddaa1b3f3 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-24T13:53:06Z |
| publishDate | 2024-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-f13ecef17b1344c080eeebbddaa1b3f32024-04-04T04:20:15ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2024-04-011110.3389/fcvm.2024.13251691325169Extending heart preservation to 24 h with normothermic perfusionBrianna L. Spencer0Spencer K. Wilhelm1Christopher Stephan2Kristopher A. Urrea3Daniela Pelaez Palacio4Robert H. Bartlett5Daniel H. Drake6Daniel H. Drake7Alvaro Rojas-Pena8Alvaro Rojas-Pena9Extracorporeal Life Support Laboratory, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, United StatesExtracorporeal Life Support Laboratory, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, United StatesExtracorporeal Life Support Laboratory, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, United StatesExtracorporeal Life Support Laboratory, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, United StatesExtracorporeal Life Support Laboratory, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, United StatesExtracorporeal Life Support Laboratory, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, United StatesExtracorporeal Life Support Laboratory, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, United StatesDepartment of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, MI, United StatesExtracorporeal Life Support Laboratory, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, United StatesDepartment of Surgery, Section of Transplantation, University of Michigan Medical School, Ann Arbor, MI, United StatesCold static storage (CSS) for up to 6 h is the gold standard in heart preservation. Although some hearts stored over 6 h have been transplanted, longer CSS times have increased posttransplant morbimortality. Transmedics® Organ Care System (OCS™) is the only FDA-approved commercial system that provides an alternative to CSS using normothermic ex situ heart perfusion (NEHP) in resting mode with aortic perfusion (Langendorff method). However, it is also limited to 6 h and lacks an objective assessment of cardiac function. Developing a system that can perfuse hearts under NEHP conditions for >24 h can facilitate organ rehabilitation, expansion of the donor pool, and objective functional evaluation. The Extracorporeal Life Support Laboratory at the University of Michigan has worked to prolong NEHP to >24 h with an objective assessment of heart viability during NEHP. An NEHP system was developed for aortic (Langendorff) perfusion using a blood-derived perfusate (leukocyte/thrombocyte-depleted blood). Porcine hearts (n = 42) of different sizes (6–55 kg) were divided into five groups and studied during 24 h NEHP with various interventions in three piglets (small-size) heart groups: (1) Control NEHP without interventions (n = 15); (2) NEHP + plasma exchange (n = 5); (3) NEHP + hemofiltration (n = 10) and two adult-size (juvenile pigs) heart groups (to demonstrate the support of larger hearts); (4) NEHP + hemofiltration (n = 5); and (5) NEHP with intermittent left atrial (iLA) perfusion (n = 7). All hearts with NEHP + interventions (n = 27) were successfully perfused for 24 h, whereas 14 (93.3%) control hearts failed between 10 and 21 h, and 1 control heart (6.6%) lasted 24 h. Hearts in the piglet hemofiltration and plasma exchange groups performed better than those in the control group. The larger hearts in the iLA perfusion group (n = 7) allowed for real-time heart functional assessment and remained stable throughout the 24 h of NEHP. These results demonstrate that heart preservation for 24 h is feasible with our NEHP perfusion technique. Increasing the preservation period beyond 24 h, infection control, and nutritional support all need optimization. This proves the concept that NEHP has the potential to increase the organ pool by (1) considering previously discarded hearts; (2) performing an objective assessment of heart function; (3) increasing the donor/recipient distance; and (4) developing heart-specific perfusion therapies.https://www.frontiersin.org/articles/10.3389/fcvm.2024.1325169/fullheart preservationnormothermicex situex vivoprolongedperfusion |
| spellingShingle | Brianna L. Spencer Spencer K. Wilhelm Christopher Stephan Kristopher A. Urrea Daniela Pelaez Palacio Robert H. Bartlett Daniel H. Drake Daniel H. Drake Alvaro Rojas-Pena Alvaro Rojas-Pena Extending heart preservation to 24 h with normothermic perfusion Frontiers in Cardiovascular Medicine heart preservation normothermic ex situ ex vivo prolonged perfusion |
| title | Extending heart preservation to 24 h with normothermic perfusion |
| title_full | Extending heart preservation to 24 h with normothermic perfusion |
| title_fullStr | Extending heart preservation to 24 h with normothermic perfusion |
| title_full_unstemmed | Extending heart preservation to 24 h with normothermic perfusion |
| title_short | Extending heart preservation to 24 h with normothermic perfusion |
| title_sort | extending heart preservation to 24 h with normothermic perfusion |
| topic | heart preservation normothermic ex situ ex vivo prolonged perfusion |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2024.1325169/full |
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