Intermittent antegrade cardioplegia: Isolated heart preservation with the Asporto heart preservation device

Andrew L. Rivard, Christina Hellmich, Cory M. Swingen, Forum D. Kamdar, Erin J. Cordova, Jonathan Holstad, Thomas J. Baranowski, Richard W. Bianco, Ranjit John

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background - A major problem in procurement of donor hearts is the limited time a donor heart remains viable. After cardiectomy, ischemic hypoxia is the main cause of donor heart degradation. The global myocardial ischemia causes a cascade of oxygen radical formation that cumulates in an elevation in hydrogen ions (decrease in pH), irreversible cellular injury, and potential microvascular changes in perfusion. Objective - To determine the changes of prolonged storage times on donor heart micro vasculature and the effects of intermittent antegrade perfusion. Materials and Methods - Using porcine hearts flushed with a Ribosol-based cardioplegic solution, we examined how storage time affects microvascular myocardial perfusion by using contrast-enhanced magnetic resonance imaging at a mean (SD) of 6.1 (0.6) hours (n = 13) or 15.6 (0.6) hours (n = 11) after cardiectomy. Finally, to determine if administration of cardioplegic solution affects pH and microvascular perfusion, isolated hearts (group 1, n = 9) given a single antegrade dose, were compared with hearts (group 2, n = 8) given intermittent antegrade cardioplegia (150 mL, every 30 min, 150 mL/min) by a heart preservation device. Khuri pH probes in left and right ventricular tissue continuously measured hydrogen ion levels, and perfusion intensity on magnetic resonance images was plotted against time. Results - Myocardial perfusion measured via magnetic resonance imaging at 6.1 hours was significantly greater than at 15.6 hours (67% vs 30%, P = .00008). In group 1 hearts, the mean (SD) for pH at the end of 6 hours decreased to 6.2 (0.2). In group 2, hearts that received intermittent antegrade cardioplegia, pH at the end of 6 hours was higher at 6.7 (0.3) (P = .0005). Magnetic resonance imaging showed no significant differences between the 2 groups in contrast enhancement (group 1, 62%; group 2, 40%) or in the wet/dry weight ratio. Conclusion - Intermittent perfusion maintains a significantly higher myocardial pH than does a conventional single antegrade dose. This difference may translate into an improved quality of donor hearts procured for transplantation, allowing longer distance procurement, tissue matching, improved outcomes for transplant recipients, and ideally a decrease in transplant-related costs.

Original languageEnglish (US)
Pages (from-to)127-133
Number of pages7
JournalProgress in Transplantation
Volume18
Issue number2
DOIs
StatePublished - Jun 2008

Fingerprint Dive into the research topics of 'Intermittent antegrade cardioplegia: Isolated heart preservation with the Asporto heart preservation device'. Together they form a unique fingerprint.

Cite this