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Tchouta L, Drake D, Hoenerhoff M, et al. Twenty-four-hour normothermic perfusion of isolated ex vivo hearts using plasma exchange. J Thorac Cardiovasc Surg. 2020;doi: 10.1016/j.jtcvs.2020.11.158.
Tchouta, L., Drake, D., Hoenerhoff, M., Rojas-Pena, A., Haft, J., Owens, G., Bartlett, R. (2020). Twenty-four-hour normothermic perfusion of isolated ex vivo hearts using plasma exchange. The Journal of thoracic and cardiovascular surgery, . https://doi.org/10.1016/j.jtcvs.2020.11.158
Tchouta, Lise, et al. "Twenty-four-hour normothermic perfusion of isolated ex vivo hearts using plasma exchange." The Journal of thoracic and cardiovascular surgery vol. (2020). doi: https://doi.org/10.1016/j.jtcvs.2020.11.158
Tchouta L, Drake D, Hoenerhoff M, Rojas-Pena A, Haft J, Owens G, Bartlett R. Twenty-four-hour normothermic perfusion of isolated ex vivo hearts using plasma exchange. J Thorac Cardiovasc Surg. 2020 Dec 13; doi: 10.1016/j.jtcvs.2020.11.158. Epub 2020 Dec 13. PMID: 33485659.
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J Thorac Cardiovasc Surg. 2020 Dec 13; doi: 10.1016/j.jtcvs.2020.11.158. Epub 2020 Dec 13.

Twenty-four-hour normothermic perfusion of isolated ex vivo hearts using plasma exchange.

The Journal of thoracic and cardiovascular surgery

Lise Tchouta, Daniel Drake, Mark Hoenerhoff, Alvaro Rojas-Pena, Jonathan Haft, Gabe Owens, Robert Bartlett,

Affiliations

  1. Department of Surgery, Columbia University Medical Center, New York, NY; Extracorporeal Life Support Laboratory, Department of Surgery, University of Michigan Health Systems, Ann Arbor, Mich.
  2. Extracorporeal Life Support Laboratory, Department of Surgery, University of Michigan Health Systems, Ann Arbor, Mich.
  3. In Vivo Animal Core Unit for Laboratory Animal Medicine, University of Michigan Medical School, Ann Arbor, Mich.
  4. Extracorporeal Life Support Laboratory, Department of Surgery, University of Michigan Health Systems, Ann Arbor, Mich; Section of Transplant Surgery, Department of Surgery, University of Michigan Health Systems, Ann Arbor, Mich.
  5. Department of Cardiac Surgery, University of Michigan Health Systems, Ann Arbor, Mich.
  6. Department of Pediatric Cardiology, University of Michigan Health Systems, Ann Arbor, Mich.
  7. Extracorporeal Life Support Laboratory, Department of Surgery, University of Michigan Health Systems, Ann Arbor, Mich. Electronic address: [email protected].

PMID: 33485659 DOI: 10.1016/j.jtcvs.2020.11.158

Abstract

OBJECTIVE: Cross-circulation of plasma from a paracorporeal animal allows successful ex vivo heart perfusion (EVHP) for 3 days. Little is known about the feasibility of prolonged EVHP without a paracorporeal animal. These experiments evaluated plasma exchange (PX) that infuses fresh plasma, whereas an equal amount is removed to replace paracorporeal cross-circulation.

METHODS: Ten hearts were procured from 8 to 10 kg piglets and maintained with EVHP. The EVHP circuit was primed with platelet- and leukocyte-reduced blood. Plasma obtained from stored porcine blood (4°C for ≤7 days) was infused and removed with a plasma separator at 1 mL/h/g cardiac tissue (n = 5) in the PX group. Controls (n = 5) used the same EVHP without PX. Antegrade aortic perfusion was adjusted to reach physiologic coronary flow of 0.7 to 1.2 mL/min/g, normothermia (37°C), and hemoglobin ≥8 g/dL. Viability was assessed by hemodynamic metrics, metabolic assays, and histopathology.

RESULTS: All PX hearts remained viable for 24 hours compared with only 1 control (P = .015). Coronary resistance was higher in the PX versus controls (1.06 ± 0.06 mm Hg/mL/min; 0.58 ± 0.02 mm Hg/mL/min [P < .05]). Lactate levels were lower in PX (2.8-4.2 mmol/L) versus controls (3.6-7.6 mmol/L) (P < .05). PX demonstrated a trend toward preservation of left ventricle systolic pressure (63.0 ± 10.9 mm Hg) versus controls (37 ± 22.0 mm Hg) (P > .05). In mixed effect models, oxygen consumption was higher with PX (P < .05). Histopathologic evaluation confirmed extensive myocardial degeneration and worse interstitial edema in controls.

CONCLUSIONS: These results demonstrate that EVHP can be successfully maintained for at least 24 hours using continuous PX. This eliminates the need for a paracorporeal animal and provides an important step toward clinical application.

Copyright © 2020 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Keywords: extracorporeal; ex vivo heart perfusion; heart transplantation; normothermic perfusion; plasma exchange

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