Myocardial oxygen handling and metabolic function of ex-situ perfused human hearts from circulatory death donors
Jorik H. Amesz, MSc,
Sanne J.J. Langmuur, BSc,
Mark F.A. Bierhuizen, MD, LLM,
Dwight Dumay, BSc,
Pieter C. van de Woestijne, MD,
Jelena Sjatskig, MD,
Lisa E. Sluijter, MSc,
Dirk J. Duncker, MD, PhD,
Olivier C. Manintveld, MD, PhD,
Yannick J.H.J. Taverne, MD, PhD, MSc
Affiliations
Jorik H. Amesz, MSc
Translational Cardiothoracic Surgery Research Lab, Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
Sanne J.J. Langmuur, BSc
Translational Cardiothoracic Surgery Research Lab, Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands; Erasmus MC Transplant Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
Mark F.A. Bierhuizen, MD, LLM
Translational Cardiothoracic Surgery Research Lab, Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
Dwight Dumay, BSc
Clinical Perfusion, Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
Pieter C. van de Woestijne, MD
Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
Jelena Sjatskig, MD
Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
Lisa E. Sluijter, MSc
Clinical Perfusion, Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
Dirk J. Duncker, MD, PhD
Division of Experimental Cardiology, Department of Cardiology, Erasmus MC Cardiovascular Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
Olivier C. Manintveld, MD, PhD
Erasmus MC Transplant Institute, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
Yannick J.H.J. Taverne, MD, PhD, MSc
Translational Cardiothoracic Surgery Research Lab, Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands; Erasmus MC Transplant Institute, Erasmus University Medical Center, Rotterdam, the Netherlands; Corresponding author: Yannick J.H.J. Taverne, MD, PhD, MSc, Department of Cardiothoracic Surgery, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015GD Rotterdam, the Netherlands.
Background: This study investigated oxygen handling of human hearts donated after circulatory death (DCD) on normothermic ex-situ heart perfusion (ESHP) and evaluated oxygen handling markers as adjuncts to cardiac viability assessment. Methods: This single-center retrospective study included human DCD heart transplantation procedures using ESHP. Lactate concentrations, blood gas, myocardial oxygen consumption (MVO2), delivery (MDO2), and extraction (MEO2), coronary blood flow (CBF), coronary vascular resistance (CVR), and adenosine infusion were reported over time. Correlation between parameters was assessed, and statistical testing compared patients who did and did not require extracorporeal membrane oxygenation (ECMO) support after transplantation. Results: Lactate concentrations decreased during ESHP in all transplanted hearts (n = 25) and increased in 1 rejected heart. Arterial partial pressure of oxygen (PO2) was 75.2 ± 2.9 kPa, with an arteriovenous ΔPO2 of 44.8 ± 10.4 kPa. Oxygen saturation was 100% in most arterial and venous samples. Average MVO2 was 2.7 ± 0.6 ml/min/100 g myocardium, MDO2 98.5 ± 20.4 ml/min, and MEO2 8.6 ± 1.8%. Average CVR was 0.025 ± 0.006 mm Hg min/ml/100 g and increased over time. ΔPO2 correlated strongly with MVO2 (R = 0.797, p < 0.001) and lactate trend (R = 0.799, p < 0.001) in transplanted hearts, without differences compared to the rejected heart with increasing lactate. Adenosine infusion on ESHP was significantly higher in patients requiring ECMO post-transplantation vs non-ECMO cases (11.7 (4.5-21.0) vs 2.2 (1.5-6.7) ml/h, p = 0.039). Conclusions: Hearts on normothermic ESHP receive excessive MDO2, due to high PO2 and CBF, while the MVO2 is relatively low. Thus, CBF and PO2 can potentially be lowered. Furthermore, ΔPO2 could serve as additional marker of metabolic function under these hyperoxic circumstances. The adenosine infusion rate might predict post-transplantation ECMO requirement.
