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Normothermic Ex-Vivo Heart Perfusion: Effects of Live Animal Blood and Plasma Cross-Circulation.

Church, Joseph T. MD; Alghanem, Fares BS; Deatrick, Kristopher B. MD; Trahanas, John M. MD; Phillips, Joseph P. BS; Song, Min Hee BS; Perkins, Elena M. BS; Bartlett, Robert H. MD; Rojas-Pena, Alvaro MD; Bocks, Martin L. MD; Owens, Gabe E. MD,PhD
doi: 10.1097/MAT.0000000000000583
Original Article: PDF Only

Prolonged normothermic ex-vivo heart perfusion (NEVHP) could transform cardiac transplantation. To help identify perfusate components that might enable long-term perfusion, we evaluated the effects of cross-circulated whole blood and cross-circulated plasma from a live paracorporeal animal on donor porcine hearts preserved via NEVHP. Standard perfusion (n=40) utilized red blood cell/plasma perfusate and Langendorf technique for a goal of 12 hours. Cross-circulation groups used a similar circuit with the addition of cross-circulated venous whole blood (XC-Blood; n=6) or cross-circulated filtered plasma (XC-Plasma; n=7) between a live paracorporeal pig under anesthesia and the perfusate reservoir. Data included oxygen metabolism, vascular resistance, lactate production, left ventricular function, myocardial electrical impedance, and histopathologic injury score. All cross-circulation hearts were successfully perfused for 12 hours, compared to 22 of 40 standard perfusion hearts (55%; p=0.002). Both cross-circulation groups demonstrated higher oxygen consumption and vascular resistance than standard hearts from hours 3-12. No significant differences were seen between XC-Blood and XC-Plasma hearts in any variable, including left ventricular dP/dT after 12 hours (1478 +/- 700mmHg/s vs. 872 +/- 500; p=0.17). We conclude that cross circulation of whole blood or plasma from a live animal improves preservation of function of perfused hearts, and cross-circulated plasma performs similarly to cross-circulated whole blood.

Copyright (C) 2017 by the American Society for Artificial Internal Organs