Monitoring of perfusion quality and prediction of donor heart function during ex-vivo machine perfusion by myocardial microcirculation versus surrogate parameters

Lars Saemann; Folker Wenzel; Matthias Kohl; Sevil Korkmaz-Icöz; Fabio Hoorn; Sivakkanan Loganathan; Yuxing Guo; Qingwei Ding; Pengyu Zhou; Gábor Veres; Matthias Karck; Gábor Szabó

doi:10.1016/j.healun.2021.02.013

Monitoring of perfusion quality and prediction of donor heart function during ex-vivo machine perfusion by myocardial microcirculation versus surrogate parameters

J Heart Lung Transplant. 2021 May;40(5):387-391. doi: 10.1016/j.healun.2021.02.013. Epub 2021 Feb 22.

Authors

Affiliations

¹ Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany; Department of Cardiac Surgery, University of Halle, Halle, Germany; Faculty Medical and Life Sciences, Furtwangen University, Villingen-Schwenningen, Germany. Electronic address: lars.saemann@uni-heidelberg.de.
² Faculty Medical and Life Sciences, Furtwangen University, Villingen-Schwenningen, Germany.
³ Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany.
⁴ Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany; Faculty Medical and Life Sciences, Furtwangen University, Villingen-Schwenningen, Germany.
⁵ Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany; Department of Cardiac Surgery, University of Halle, Halle, Germany; Department of Anesthesiology, Ruhr-University Bochum, St. Josef- and St. Elisabeth Hospital, Bochum, Germany.
⁶ Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany; Department of Cardiac Surgery, University of Halle, Halle, Germany.

PMID: 33726982
DOI: 10.1016/j.healun.2021.02.013

Abstract

Currently, lactate (Lac) is used to evaluate machine perfusion (MP) of hearts, donated after circulatory death (DCD). We hypothesize that monitoring of myocardial microcirculation (mLDP) by Laser-Doppler-Perfusion is superior to Lac to evaluate perfusion and predict contractility. In a pig model, DCD-hearts were perfused 4 hours followed by reperfusion and left ventricular contractility measurement. Lac and mLDP were measured every 30 min in successfully (N = 9) and unsuccessfully (N = 7) maintained hearts. Successfully maintained hearts showed decreasing Lac (5.6 to 2.8 mmol/L) and slightly downregulated (92%) mLDP. In unsuccessfully maintained hearts Lac first decreased (5.1 to 3.8 mmol/L) followed by increase and mLDP dropped to 39%. In a single-variable regression only mLDP showed a significant r² for systolic (0.514, p = 0.045) and diastolic (0.501, p = 0.049) parameters. The combination of mLDP and Lac (r² = 0.876, p = 0.005) showed best results. mLDP seems to be superior to Lac to show perfusion disorders and predict DCD-heart contractility.

Keywords: donation after circulatory death; ex-vivo machine perfusion; heart transplantation; myocardial microcirculation; risk prediction model.

MeSH terms

Animals
Coronary Circulation / physiology*
Disease Models, Animal
Heart Transplantation / methods*
Microcirculation / physiology*
Myocardial Contraction / physiology*
Organ Preservation / methods*
Perfusion / standards*
Swine
Tissue Donors*