Abstract 10125: Successful Transplantation in Canines After Long-Term Coronary Sinus Machine Perfusion Preservation of Donor Hearts
Introduction: Machine perfusion is a promising strategy for donor heart preservation but delivery of perfusate through the ascending aorta may be limited by aortic valve incompetence. We hypothesize that retrograde machine perfusion preservation through the coronary sinus avoids this issue and allows for recovery of donor hearts after long-term storage.
Methods: Canine hearts were procured after cardioplegic arrest with 1 Liter University of Wisconsin Machine Perfusion Solution (UWMPS) and preserved for 12 hours in UWMPS by either conventional static storage (Static group, n=5) at 0-4°C or retrograde machine perfusion through the coronary sinus (RP group, n=5) at 5°C. Myocardial oxygen consumption (MVO2) and lactate accumulation were monitored in perfused hearts. Donor hearts were implanted into recipient animals and reperfused for six hours. The preload recruitable stroke work (PRSW) was determined hourly as a load independent measure of myocardial function. Total CK was measured. Cell death was quantified by TUNEL on tissue sections.
Results: MVO2 remained stable and lactate accumulation was low in RP hearts. All RP hearts separated from cardiopulmonary bypass (CPB). All Static group hearts either did not separate from CPB or required a return to CPB by the end of the reperfusion interval (p<.05). After 6 hours reperfusion, PRSW in RP hearts was increased compared to the Static group (p<.05) and did not differ from baseline values. CK release was greater in Static group hearts (p<.05). TUNEL demonstrated more dead cells in the Static group but this difference was not significant. See Table.
Conclusion: Retrograde machine perfusion can preserve donor hearts for long intervals. Cardiac function after implantation was not different from baseline function suggesting excellent myocardial protection. A retrograde machine perfusion strategy appears promising for safely extending the donor ischemic interval and improving results of heart transplantation.
- © 2013 by American Heart Association, Inc.