Characterizing cardiac donation after circulatory death: implications for perfusion preservation.

Background: Donation after circulatory determination of death (DCDD) involves variable definitions of death among hospitals, and DCDD hearts are not generally considered for transplantation. The definition can affect ischemic times, and machine perfusion preservation appears promising for recovery of DCDD hearts. The purpose of the current study was to investigate the agonal phase of DCDD donors and evaluate retrograde perfusion preservation of DCDD donor hearts in a large animal model of cardiac transplantation.

Metabolic characteristics of human hearts preserved for 12 hours by static storage, antegrade perfusion, or retrograde coronary sinus perfusion.

Objective: Machine perfusion of donor hearts is a promising strategy to increase the donor pool. Antegrade perfusion is effective but can lead to aortic valve incompetence and nonnutrient flow. Experience with retrograde coronary sinus perfusion of donor hearts has been limited.

Differences in regional myocardial perfusion, metabolism, MVO2, and edema after coronary sinus machine perfusion preservation of canine hearts.

Machine perfusion improves solid organ preservation for transplantation. We have demonstrated that antegrade perfusion preservation of hearts is superior to cold storage but may be limited by aortic valve incompetence. We hypothesized that retrograde perfusion (RP) through the coronary sinus may provide more reliable perfusate delivery to the heart.

Glucose is an ineffective substrate for preservation of machine perfused donor hearts.

Background: Machine perfusion with oxygenated preservation solution can support donor heart metabolism but the preservation solution should contain an oxidizable substrate to improve cellular energetics. We hypothesized that myocardial metabolism can be influenced by exogenous substrates in the preservation solution.

Methods: Eight groups of isolated rat hearts (n = 4/group) were perfused with University of Wisconsin Machine Perfusion Solution containing carbon 13 ((13)C) labeled glucose (2.

Machine perfusion for cardiac allograft preservation.

Purpose Of Review: The current cardiac preservation strategy for cardiac transplantation involves arresting hearts with a crystalloid preservation solution and storing them in this solution in an ice chest. This technique has allowed good results in heart transplantation, but has limited the transport interval, and has not encouraged major efforts to expand the donor pool. Machine perfusion of explanted organs, a technique used clinically in kidney transplantation, is now under active investigation in the cardiac arena.

Myocardial perfusion characteristics during machine perfusion for heart transplantation.

Background: Optimal parameters for machine perfusion preservation of hearts prior to transplantation have not been determined. We sought to define regional myocardial perfusion characteristics of a machine perfusion device over a range of conditions in a large animal model.

Methods: Dog hearts were connected to a perfusion device (LifeCradle, Organ Transport Systems, Inc, Frisco, TX) and cold perfused at differing flow rates (1) at initial device startup and (2) over the storage interval.