A Cardioprotective perfusion protocol limits myocardial functional decline during ex situ heart perfusion
Mats T. Vervoorn, MD,
Elisa M. Ballan, MSc,
Sjoerd van Tuijl, MSc,
Saskia C.A. de Jager, PhD,
Selma E. Kaffka genaamd Dengler, MD,
Joost P.G. Sluijter, PhD,
Pieter A. Doevendans, MD, PhD,
Niels P. van der Kaaij, MD, PhD
Affiliations
Mats T. Vervoorn, MD
University Medical Center Utrecht, Department of Cardiothoracic Surgery, Division of Heart & Lungs, Utrecht, the Netherlands
Elisa M. Ballan, MSc
University Medical Center Utrecht, Department of Cardiothoracic Surgery, Division of Heart & Lungs, Utrecht, the Netherlands; University Medical Center Utrecht, Department of Cardiology, Laboratory of Experimental Cardiology, Division Heart & Lungs, Utrecht, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands
Sjoerd van Tuijl, MSc
LifeTec Group B.V., Eindhoven, the Netherlands
Saskia C.A. de Jager, PhD
University Medical Center Utrecht, Department of Cardiology, Laboratory of Experimental Cardiology, Division Heart & Lungs, Utrecht, the Netherlands
Selma E. Kaffka genaamd Dengler, MD
University Medical Center Utrecht, Department of Cardiothoracic Surgery, Division of Heart & Lungs, Utrecht, the Netherlands
Joost P.G. Sluijter, PhD
University Medical Center Utrecht, Department of Cardiology, Laboratory of Experimental Cardiology, Division Heart & Lungs, Utrecht, the Netherlands; Regenerative Medicine Utrecht, Circulatory Health Research Center, University Utrecht, Utrecht, the Netherlands
Pieter A. Doevendans, MD, PhD
Netherlands Heart Institute, Utrecht, the Netherlands; University Medical Center Utrecht, Department of Cardiology, Division Heart & Lungs, Utrecht, the Netherlands
Niels P. van der Kaaij, MD, PhD
University Medical Center Utrecht, Department of Cardiothoracic Surgery, Division of Heart & Lungs, Utrecht, the Netherlands; Corresponding author: Niels P. van der Kaaij, MD, PhD, University Medical Center Utrecht, Department of Cardiothoracic Surgery, P.O. Box 85500, Utrecht, 3508 GA, the Netherlands.
Background: Ex situ heart perfusion is associated with a significant decline in graft quality related to oxidative stress, inflammation, endothelial dysfunction, and metabolic perturbations. We assessed the effects of a more optimized, cardioprotective normothermic perfusion approach compared to a conventional perfusion protocol in a slaughterhouse model using porcine hearts. Methods: A total of 12 hearts were harvested and subjected to 4 hours of normothermic perfusion. The optimized protocol consisted of an adenosine-lidocaine cardioplegic solution, subnormothermic initial reperfusion and controlled rewarming, hemofiltration and supplementation of methylprednisolone and pyruvate. This was compared to a conventional protocol consisting of St. Thomas II cardioplegic solution, normothermic initial reperfusion without hemofiltration or methylprednisolone, and a mixture of glucose and insulin for metabolic support. Results: Myocardial function was superior in the optimized group, while significant functional decline was absent. Hearts subjected to the conventional protocol demonstrated a significant reduction in function over time. Conclusions: We have developed a further optimized, cardioprotective normothermic ex situ heart perfusion approach and demonstrated significantly improved myocardial function and attenuated functional decline during 4 hours of normothermic perfusion, indicating improved preservation.
