Back to 2024 Display ePosters
Assessment Tools In Ex-situ Heart Perfusion - An Evaluation In A Pig Model
Lukas Stastny, Alexander Egger, Nina Hofmann, Gabriel Putzer, Natalie Huemer, Alexandra Ampferer, Florian Sommerauer, Judith Martini, Michael Grimm, Nikolaos Bonaros, Julia Dumfarth;
Medical University of Innsbruck, Innsbruck, Austria
BACKGROUND: Ex-situ heart perfusion (ESHP) enables the resuscitation and assessment of donor hearts. Therefore, a comprehensive analysis of myocardial function and metabolism is crucial. Currently, the only used assessment tool for quality control is sequential lactate measurement from the perfusate. The aim of this study was to investigate new assessment tools in ESHP.
METHODS:12 German domestic pigs
were used as heart and blood donors. “Donation after brain death” (DBD) (n=6) and “donation after circulatory death” (DCD) (n=6) were simulated and 6 hours of normothermic ESHP was performed. Analysis were performed at 1 (T1), 3 (T2) and 6 (T3) hours of perfusion. Different assessment tools were used to analyse functional status (left ventricular pressure balloon [LVPB], visual cardiac score [VCS]) and myocardial damage and metabolic in the perfusate (lactate, myoglobin, high-sensitive [hs] troponin t). Additionally, microdialysis catheters were inserted in the myocardium of the left ventricle. Subsequently, lactate, pyruvate, and glycerol were analysed.
RESULTS:Parameters of myocardial damage increased in both groups and were significantly higher in the DCD group: myoglobin (T1: DCD 1154±444.7 vs. DBD 385.2±113.8µg/l, p=0.011; T3: DCD 2002±571.4 vs. DBD 652±117.2 µg/l, p=0.003), hs troponin T (T1: DCD 44796±46581 vs. DBD 12229±6447ng/l, p=0.159; T3: DCD 446742±315830 vs. DBD 102496±33448 ng/l, p=0.044). Functional assessment revealed a decline during ESHP in both groups. LVPB did not differ between the groups (T1: DCD 160±97 vs. DBD 204±83mmHg, p=0.354; T3: DCD 66±38 vs. DBD 104±40mmHg, p=0.250), whereas VAS was significantly lower in DCD group (T1: DCD 7.3±0.8 vs. DBD 7.8±1.2, p=0.490; T3: DCD 2.7±1.0 vs. DBD 5.8±1.5, p=0.002).
Interstitial levels of lactate, pyruvate, and glycerol did not differ at baseline between the two groups. Pyruvate increased significantly faster in the DCD group once ESHP was implemented (
20min: DCD 162.8 ±124.4 µmol/ vs. DBD 26.41 ±23.97 µmol/l, p=0.04). Glycerol was stable during ESHP in the DBD group but was significantly higher in the DCD group with a rapid increase directly after reperfusion (20min: DCD 783.79±280.02 µmol/l vs. DBD 105 µmol/l±71.73, p<0.001).
CONCLUSIONS:Additional assessment tools in ESHP are urgently necessary. Biomarker and microdialysis are both feasible and able to detect metabolic and functional changes.
Back to 2024 Display ePosters
