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Schmiady MO, Bec LP, Shallah M, Flammer AJ, Vogt PR, Wilhelm MJ. Long-distance donor heart procurement using an innovative cold static storage system. Perfusion 2024; 39:1006-1008. [PMID: 36905360 PMCID: PMC11191656 DOI: 10.1177/02676591231163018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
The global lack of donor shortage poses a major limitation for heart transplantation. New concepts with expanded donor inclusion criteria comprise extended transport distances and prolonged ischemic times with the aim of reaching a larger number of potential donors. Recent developments in cold storage solutions may allow more donor hearts with prolonged ischemic times to be use for transplantation in the future. We present our experience during a long-distance donor heart procurement with the longest reported transport distance and transport time in the current literature. This was made possible through the use of SherpaPak™, an innovative cold storage system which allows for controlled temperatures during transportation.
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Affiliation(s)
- Martin O Schmiady
- Clinic for Cardiac Surgery, University Heart Center, Zurich, Switzerland
| | - Leszek P Bec
- Clinic for Cardiac Surgery, University Heart Center, Zurich, Switzerland
| | - Mohammed Shallah
- Clinic for Cardiac Surgery, University Heart Center, Zurich, Switzerland
| | | | - Paul R Vogt
- Clinic for Cardiac Surgery, University Heart Center, Zurich, Switzerland
| | - Markus J Wilhelm
- Clinic for Cardiac Surgery, University Heart Center, Zurich, Switzerland
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2
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D'Alessandro D, Schroder J, Meyer DM, Vidic A, Shudo Y, Silvestry S, Leacche M, Sciortino CM, Rodrigo ME, Pham SM, Copeland H, Jacobs JP, Kawabori M, Takeda K, Zuckermann A. Impact of controlled hypothermic preservation on outcomes following heart transplantation. J Heart Lung Transplant 2024; 43:1153-1161. [PMID: 38503386 DOI: 10.1016/j.healun.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/09/2024] [Accepted: 03/14/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Severe primary graft dysfunction (PGD) is a major cause of early mortality after heart transplant, but the impact of donor organ preservation conditions on severity of PGD and survival has not been well characterized. METHODS Data from US adult heart-transplant recipients in the Global Utilization and Registry Database for Improved Heart Preservation-Heart Registry (NCT04141605) were analyzed to quantify PGD severity, mortality, and associated risk factors. The independent contributions of organ preservation method (traditional ice storage vs controlled hypothermic preservation) and ischemic time were analyzed using propensity matching and logistic regression. RESULTS Among 1,061 US adult heart transplants performed between October 2015 and December 2022, controlled hypothermic preservation was associated with a significant reduction in the incidence of severe PGD compared to ice (6.6% [37/559] vs 10.4% [47/452], p = 0.039). Following propensity matching, severe PGD was reduced by 50% (6.0% [17/281] vs 12.1% [34/281], respectively; p = 0.018). The Kaplan-Meier terminal probability of 1-year mortality was 4.2% for recipients without PGD, 7.2% for mild or moderate PGD, and 32.1%, for severe PGD (p < 0.001). The probability of severe PGD increased for both cohorts with longer ischemic time, but donor hearts stored on ice were more likely to develop severe PGD at all ischemic times compared to controlled hypothermic preservation. CONCLUSIONS Severe PGD is the deadliest complication of heart transplantation and is associated with a 7.8-fold increase in probability of 1-year mortality. Controlled hypothermic preservation significantly attenuates the risk of severe PGD and is a simple yet highly effective tool for mitigating post-transplant morbidity.
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Affiliation(s)
- David D'Alessandro
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
| | - Jacob Schroder
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Dan M Meyer
- Department of Cardiothoracic Surgery, Baylor University Medical Center, Dallas, Texas
| | - Andrija Vidic
- Department of Cardiovascular Medicine University of Kansas Health System, Kansas City, Kansas
| | - Yasuhiro Shudo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Scott Silvestry
- Department of Cardiothoracic Surgery, AdventHealth Transplant Institute, Orlando, Florida
| | - Marzia Leacche
- Division of Cardiothoracic Surgery, Corewell Health (formerly Spectrum Health), Grand Rapids, Michigan
| | | | - Maria E Rodrigo
- Department of Cardiology, MedStar Health, Washington, District of Columbia
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Hannah Copeland
- Department of Cardiothoracic Surgery, Lutheran Health, Fort Wayne, Indiana
| | - Jeffrey P Jacobs
- Division of Cardiovascular Surgery, Congenital Heart Center, UF Health Shands Hospital, Gainesville, Florida
| | - Masashi Kawabori
- Department of Surgery, Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts
| | - Koji Takeda
- Division of Cardiac, Thoracic & Vascular Surgery, Department of Surgery, Columbia University, New York, New York
| | - Andreas Zuckermann
- Department for Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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3
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Al-Ani MAZ, Farr MA, Shah P. Cold precision: Enhancing organ preservation with controlled hypothermia. J Heart Lung Transplant 2024:S1053-2498(24)01663-2. [PMID: 38759764 DOI: 10.1016/j.healun.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 05/03/2024] [Accepted: 05/08/2024] [Indexed: 05/19/2024] Open
Affiliation(s)
- Mohammad A Z Al-Ani
- Advanced Heart Failure & Transplantation, Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, Florida
| | - Maryjane A Farr
- Advanced Heart Failure, University of Texas Southwestern University, Dallas, Texas
| | - Palak Shah
- Advanced Heart Failure, Inova Schar Heart and Vascular, Falls Church, Virginia.
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Silvestry S, Leacche M, Meyer DM, Shudo Y, Kawabori M, Mahesh B, Zuckermann A, D’Alessandro D, Schroder J. Outcomes in Heart Transplant Recipients by Bridge to Transplant Strategy When Using the SherpaPak Cardiac Transport System. ASAIO J 2024; 70:388-395. [PMID: 38300893 PMCID: PMC11057488 DOI: 10.1097/mat.0000000000002137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
The last several years have seen a rise in use of mechanical circulatory support (MCS) to bridge heart transplant recipients. A controlled hypothermic organ preservation system, the SherpaPak Cardiac Transport System (SCTS), was introduced in 2018 and has grown in utilization with reports of improved posttransplant outcomes. The Global Utilization And Registry Database for Improved heArt preservatioN (GUARDIAN)-Heart registry is an international, multicenter registry assessing outcomes after transplant using the SCTS. This analysis examines outcomes in recipients bridged with various MCS devices in the GUARDIAN-Heart Registry. A total of 422 recipients with donor hearts transported using SCTS were included and identified. Durable ventricular assist devices (VADs) were used exclusively in 179 recipients, temporary VADs or intra-aortic balloon pump (IABP) in 197, and extracorporeal membrane oxygenation (ECMO) in 14 recipients. Average ischemic times were over 3.5 hours in all cohorts. Severe primary graft dysfunction (PGD) posttransplant increased across groups (4.5% VAD, 5.1% temporary support, 21.4% ECMO), whereas intensive care unit (ICU) length of stay (18.2 days) and total hospital stay (39.4 days) was longer in the ECMO cohort than the VAD and IABP groups. A comparison of outcomes of MCS bridging in SCTS versus traditional ice revealed significantly lower rates of both moderate/severe right ventricular (RV) dysfunction and severe PGD in the SCTS cohort; however, upon propensity matching only the reductions in moderate/severe RV dysfunction were statistically significant. Use of SCTS in transplant recipients with various bridging strategies results in excellent outcomes.
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Affiliation(s)
- Scott Silvestry
- From the Department of Cardiothoracic Surgery, AdventHealth Transplant Institute, Orlando, Florida
| | - Marzia Leacche
- Division of Cardiothoracic Surgery, Corewell Health (Formerly Spectrum Health), Grand Rapids, Michigan
| | - Dan M. Meyer
- Department of Cardiothoracic Surgery, Baylor University Medical Center, Dallas, Texas
| | - Yasuhiro Shudo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Masashi Kawabori
- Cardiovascular Center, Department of Surgery, Tufts Medical Center, Boston Massachusetts
| | - Balakrishnan Mahesh
- Division of Cardiac Surgery, Heart & Vascular Institute, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Andreas Zuckermann
- Department for Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - David D’Alessandro
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Jacob Schroder
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
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5
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Lerman JB, Patel CB, Casalinova S, Nicoara A, Holley CL, Leacche M, Silvestry S, Zuckermann A, D'Alessandro DA, Milano CA, Schroder JN, DeVore AD. Early Outcomes in Patients With LVAD Undergoing Heart Transplant via Use of the SherpaPak Cardiac Transport System. Circ Heart Fail 2024; 17:e010904. [PMID: 38602105 DOI: 10.1161/circheartfailure.123.010904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 01/08/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Heart transplant (HT) in recipients with left ventricular assist devices (LVADs) is associated with poor early post-HT outcomes, including primary graft dysfunction (PGD). As complicated heart explants in recipients with LVADs may produce longer ischemic times, innovations in donor heart preservation may yield improved post-HT outcomes. The SherpaPak Cardiac Transport System is an organ preservation technology that maintains donor heart temperatures between 4 °C and 8 °C, which may minimize ischemic and cold-induced graft injuries. This analysis sought to identify whether the use of SherpaPak versus traditional cold storage was associated with differential outcomes among patients with durable LVAD undergoing HT. METHODS Global Utilization and Registry Database for Improved Heart Preservation-Heart (NCT04141605) is a multicenter registry assessing post-HT outcomes comparing 2 methods of donor heart preservation: SherpaPak versus traditional cold storage. A retrospective review of all patients with durable LVAD who underwent HT was performed. Outcomes assessed included rates of PGD, post-HT mechanical circulatory support use, and 30-day and 1-year survival. RESULTS SherpaPak (n=149) and traditional cold storage (n=178) patients had similar baseline characteristics. SherpaPak use was associated with reduced PGD (adjusted odds ratio, 0.56 [95% CI, 0.32-0.99]; P=0.045) and severe PGD (adjusted odds ratio, 0.31 [95% CI, 0.13-0.75]; P=0.009), despite an increased total ischemic time in the SherpaPak group. Propensity matched analysis also noted a trend toward reduced intensive care unit (SherpaPak 7.5±6.4 days versus traditional cold storage 11.3±18.8 days; P=0.09) and hospital (SherpaPak 20.5±11.9 days versus traditional cold storage 28.7±37.0 days; P=0.06) lengths of stay. The 30-day and 1-year survival was similar between groups. CONCLUSIONS SherpaPak use was associated with improved early post-HT outcomes among patients with LVAD undergoing HT. This innovation in preservation technology may be an option for HT candidates at increased risk for PGD. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT04141605.
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Affiliation(s)
- Joseph B Lerman
- Department of Medicine, Division of Cardiology (J.B.L., C.B.P., S.C., C.L.H., A.D.D.), Duke University Hospital, Durham, NC
| | - Chetan B Patel
- Department of Medicine, Division of Cardiology (J.B.L., C.B.P., S.C., C.L.H., A.D.D.), Duke University Hospital, Durham, NC
| | - Sarah Casalinova
- Department of Medicine, Division of Cardiology (J.B.L., C.B.P., S.C., C.L.H., A.D.D.), Duke University Hospital, Durham, NC
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, (S.C., A.N., C.A.M., J.N.S.), Duke University Hospital, Durham, NC
| | - Alina Nicoara
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, (S.C., A.N., C.A.M., J.N.S.), Duke University Hospital, Durham, NC
| | - Christopher L Holley
- Department of Medicine, Division of Cardiology (J.B.L., C.B.P., S.C., C.L.H., A.D.D.), Duke University Hospital, Durham, NC
| | - Marzia Leacche
- Division of Cardiothoracic Surgery, Corewell Health, Grand Rapids, MI (M.L.)
| | - Scott Silvestry
- Department of Cardiothoracic Surgery, AdventHealth Transplant Institute, Orlando, FL (S.S.)
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Austria (A.Z.)
| | - David A D'Alessandro
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston (D.A.D.)
| | - Carmelo A Milano
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, (S.C., A.N., C.A.M., J.N.S.), Duke University Hospital, Durham, NC
| | - Jacob N Schroder
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, (S.C., A.N., C.A.M., J.N.S.), Duke University Hospital, Durham, NC
| | - Adam D DeVore
- Department of Medicine, Division of Cardiology (J.B.L., C.B.P., S.C., C.L.H., A.D.D.), Duke University Hospital, Durham, NC
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Moayedifar R, Shudo Y, Kawabori M, Silvestry S, Schroder J, Meyer DM, Jacobs JP, D'Alessandro D, Zuckermann A. Recipient Outcomes With Extended Criteria Donors Using Advanced Heart Preservation: An Analysis of the GUARDIAN-Heart Registry. J Heart Lung Transplant 2024; 43:673-680. [PMID: 38163452 DOI: 10.1016/j.healun.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 12/20/2023] [Accepted: 12/25/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND The prevalence of end-stage heart failure and patients who could benefit from heart transplantation requires an expansion of the donor pool, relying on the transplant community to continually re-evaluate and expand the use of extended criteria donor organs. Introduction of new technologies such as the Paragonix SherpaPak Cardiac Transport System aids in this shift. We seek to analyze the impact of the SherpaPak system on recipient outcomes who receive extended criteria organs in the GUARDIAN-Heart Registry. METHODS Between October 2015 and December 2022, 1,113 adults from 15 US centers receiving donor hearts utilizing either SherpaPak (n = 560) or conventional ice storage (ice, n = 453) were analyzed from the GUARDIAN-Heart Registry using summary statistics. A previously published set of criteria was used to identify extended criteria donors, which included 193 SherpaPak and 137 ice. RESULTS There were a few baseline differences among recipients in the 2 cohorts; most notably, IMPACT scores, distance traveled, and total ischemic time were significantly greater in SherpaPak, and significantly more donor hearts in the SherpaPak cohort had >4 hours total ischemia time. Posttransplant mechanical circulatory support utilization (SherpaPak 22.3% vs ice 35.0%, p = 0.012) and new extracorporeal membrane oxygenation/ventricular assist device (SherpaPak 7.8% vs ice 15.3%, p = 0.033) was significantly reduced, and the rate of severe primary graft dysfunction (SherpaPak 6.2% vs ice 13.9%, p = 0.022) was significantly reduced by over 50% in hearts preserved using SherpaPak. One-year survival between cohorts was similar (SherpaPak 92.9% vs ice 89.6%, p = 0.27). CONCLUSIONS This subgroup analysis demonstrates that SherpaPak can be safely used to utilize extended criteria donors with low severe PGD rates.
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Affiliation(s)
- Roxana Moayedifar
- Department for Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
| | - Yasuhiro Shudo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Masashi Kawabori
- Cardiovascular Center, Department of Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Scott Silvestry
- Department of Cardiothoracic Surgery, AdventHealth Transplant Institute, Orlando, Florida
| | - Jacob Schroder
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Dan M Meyer
- Department of Cardiothoracic Surgery, Baylor University Medical Center, Dallas, Texas
| | - Jeffrey P Jacobs
- Congenital Heart Center, Division of Cardiovascular Surgery, UF Health Shands Hospital, Gainesville, Florida
| | - David D'Alessandro
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Andreas Zuckermann
- Department for Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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Lerman JB, Agarwal R, Patel CB, Keenan JE, Casalinova S, Milano CA, Schroder JN, DeVore AD. Donor Heart Recovery and Preservation Modalities in 2024. JACC. HEART FAILURE 2024; 12:427-437. [PMID: 38032571 DOI: 10.1016/j.jchf.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 10/06/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023]
Abstract
Historically, heart transplantation (HT) has relied on the use of traditional cold storage for donor heart preservation. This organ preservation modality has several limitations, including the risk for ischemic and cold-induced graft injuries that may contribute to primary graft dysfunction and poor post-HT outcomes. In recent years, several novel donor heart preservation modalities have entered clinical practice, including the SherpaPak Cardiac Transport System of controlled hypothermic preservation, and the Transmedics Organ Care System of ex vivo perfusion. Such technologies are altering the landscape of HT by expanding the geographic reach of procurement teams and enabling both donation after cardiac death and the use of expanded criteria donor hearts. This paper will review the emerging evidence on the association of these modalities with improved post-HT outcomes, and will also suggest best practices for selecting between donor heart preservation techniques.
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Affiliation(s)
- Joseph B Lerman
- Duke University Hospital, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA.
| | - Richa Agarwal
- Duke University Hospital, Durham, North Carolina, USA
| | | | | | | | | | | | - Adam D DeVore
- Duke University Hospital, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA
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McGiffin DC, Kure CE, Macdonald PS, Jansz PC, Emmanuel S, Marasco SF, Doi A, Merry C, Larbalestier R, Shah A, Geldenhuys A, Sibal AK, Wasywich CA, Mathew J, Paul E, Cheshire C, Leet A, Hare JL, Graham S, Fraser JF, Kaye DM. Hypothermic oxygenated perfusion (HOPE) safely and effectively extends acceptable donor heart preservation times: Results of the Australian and New Zealand trial. J Heart Lung Transplant 2024; 43:485-495. [PMID: 37918701 DOI: 10.1016/j.healun.2023.10.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/08/2023] [Accepted: 10/25/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Cold static storage preservation of donor hearts for periods longer than 4 hours increases the risk of primary graft dysfunction (PGD). The aim of the study was to determine if hypothermic oxygenated perfusion (HOPE) could safely prolong the preservation time of donor hearts. METHODS We conducted a nonrandomized, single arm, multicenter investigation of the effect of HOPE using the XVIVO Heart Preservation System on donor hearts with a projected preservation time of 6 to 8 hours on 30-day recipient survival and allograft function post-transplant. Each center completed 1 or 2 short preservation time followed by long preservation time cases. PGD was classified as occurring in the first 24 hours after transplantation or secondary graft dysfunction (SGD) occurring at any time with a clearly defined cause. Trial survival was compared with a comparator group based on data from the International Society of Heart and Lung Transplantation (ISHLT) Registry. RESULTS We performed heart transplants using 7 short and 29 long preservation time donor hearts placed on the HOPE system. The mean preservation time for the long preservation time cases was 414 minutes, the longest being 8 hours and 47 minutes. There was 100% survival at 30 days. One long preservation time recipient developed PGD, and 1 developed SGD. One short preservation time patient developed SGD. Thirty day survival was superior to the ISHLT comparator group despite substantially longer preservation times in the trial patients. CONCLUSIONS HOPE provides effective preservation out to preservation times of nearly 9 hours allowing retrieval from remote geographic locations.
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Affiliation(s)
- David C McGiffin
- Department of Cardiothoracic Surgery and Transplantation, The Alfred, Melbourne, Australia; Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia; Critical Care Research Group, Adult Intensive Care Unit, The Prince Charles Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia.
| | - Christina E Kure
- Department of Cardiothoracic Surgery and Transplantation, The Alfred, Melbourne, Australia; Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
| | | | - Paul C Jansz
- Department of Cardiothoracic Surgery, St Vincent's Hospital, Sydney, Australia
| | - Sam Emmanuel
- Department of Cardiothoracic Surgery, St Vincent's Hospital, Sydney, Australia
| | - Silvana F Marasco
- Department of Cardiothoracic Surgery and Transplantation, The Alfred, Melbourne, Australia; Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
| | - Atsuo Doi
- Department of Cardiothoracic Surgery and Transplantation, The Alfred, Melbourne, Australia
| | - Chris Merry
- Department of Cardiothoracic Surgery and Transplantation, The Alfred, Melbourne, Australia
| | - Robert Larbalestier
- Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Perth, Australia
| | - Amit Shah
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia
| | - Agneta Geldenhuys
- Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Perth, Australia
| | - Amul K Sibal
- Department of Cardiothoracic Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Cara A Wasywich
- Department of Cardiology, Auckland City Hospital, Auckland, New Zealand
| | - Jacob Mathew
- Department of Cardiology, Royal Children's Hospital, Melbourne, Australia
| | - Eldho Paul
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Angeline Leet
- Department of Cardiology, The Alfred, Melbourne, Australia
| | - James L Hare
- Department of Cardiology, The Alfred, Melbourne, Australia
| | - Sandra Graham
- Department of Cardiology, The Alfred, Melbourne, Australia
| | - John F Fraser
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia; Critical Care Research Group, Adult Intensive Care Unit, The Prince Charles Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia; St Andrews War Memorial Hospital, Brisbane, Australia
| | - David M Kaye
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia; Monash-Alfred-Baker Centre for Cardiovascular Research, Monash University, Melbourne, Australia
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Shudo Y, Leacche M, Copeland H, Silvestry S, Pham SM, Molina E, Schroder JN, Sciortino CM, Jacobs JP, Kawabori M, Meyer DM, Zuckermann A, D’Alessandro DA. A Paradigm Shift in Heart Preservation: Improved Post-transplant Outcomes in Recipients of Donor Hearts Preserved With the SherpaPak System. ASAIO J 2023; 69:993-1000. [PMID: 37678260 PMCID: PMC10602216 DOI: 10.1097/mat.0000000000002036] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023] Open
Abstract
Traditional ice storage has been the historic standard for preserving donor's hearts. However, this approach provides variability in cooling, increasing risks of freezing injury. To date, no preservation technology has been reported to improve survival after transplantation. The Paragonix SherpaPak Cardiac Transport System (SCTS) is a controlled hypothermic technology clinically used since 2018. Real-world evidence on clinical benefits of SCTS compared to conventional ice cold storage (ICS) was evaluated. Between October 2015 and January 2022, 569 US adults receiving donor hearts preserved and transported either in SCTS (n = 255) or ICS (n = 314) were analyzed from the Global Utilization And Registry Database for Improved heArt preservatioN (GUARDIAN-Heart) registry. Propensity matching and a subgroup analysis of >240 minutes ischemic time were performed to evaluate comparative outcomes. Overall, the SCTS cohort had significantly lower rates of severe primary graft dysfunction (PGD) ( p = 0.03). When propensity matched, SCTS had improving 1-year survival ( p = 0.10), significantly lower rates of severe PGD ( p = 0.011), and lower overall post-transplant MCS utilization ( p = 0.098). For patients with ischemic times >4 hours, the SCTS cohort had reduced post-transplant MCS utilization ( p = 0.01), reduced incidence of severe PGD ( p = 0.005), and improved 30-day survival ( p = 0.02). A multivariate analysis of independent risk factors revealed that compared to SCTS, use of ice results in a 3.4-fold greater chance of severe PGD ( p = 0.014). Utilization of SCTS is associated with a trend toward increased post-transplant survival and significantly lower severe PGD and MCS utilization. These findings fundamentally challenge the decades-long status quo of transporting donor hearts using ice.
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Affiliation(s)
- Yasuhiro Shudo
- From the Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Marzia Leacche
- Division of Cardiothoracic Surgery, Corewell Health (formerly Spectrum Health), Grand Rapids, Michigan
| | - Hannah Copeland
- Department of Cardiothoracic Surgery, Lutheran Health, Fort Wayne, Indiana
| | - Scott Silvestry
- Department of Cardiothoracic Surgery, AdventHealth Transplant Institute, Orlando, Florida
| | - Si M. Pham
- Department of Cardiovascular Surgery, Mayo Clinic, Jacksonville, Florida
| | - Ezequiel Molina
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (current affiliation: Piedmont Heart Institute, Atlanta, Georgia)
| | - Jacob N. Schroder
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | | | - Jeffrey P. Jacobs
- Division of Cardiovascular Surgery, Departments of Surgery and Pediatrics, Congenital Heart Center, UF Health Shands Hospital, Gainesville, Florida
| | - Masashi Kawabori
- Cardiovascular Center, Department of Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Dan M. Meyer
- Department of Cardiothoracic Surgery, Baylor University Medical Center, Dallas, Texas
| | - Andreas Zuckermann
- Department for Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - David A. D’Alessandro
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston Massachusetts
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Lechiancole A, Sponga S, Benedetti G, Semeraro A, Guzzi G, Daffarra C, Meneguzzi M, Nalli C, Piani D, Bressan M, Livi U, Vendramin I. Graft preservation in heart transplantation: current approaches. Front Cardiovasc Med 2023; 10:1253579. [PMID: 37636303 PMCID: PMC10450939 DOI: 10.3389/fcvm.2023.1253579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/01/2023] [Indexed: 08/29/2023] Open
Abstract
Heart transplantation (HTx) represents the current best surgical treatment for patients affected by end-stage heart failure. However, with the improvement of medical and interventional therapies, the population of HTx candidates is increasingly old and at high-risk for mortality and complications. Moreover, the use of "extended donor criteria" to deal with the shortage of donors could increase the risk of worse outcomes after HTx. In this setting, the strategy of donor organ preservation could significantly affect HTx results. The most widely used technique for donor organ preservation is static cold storage in ice. New techniques that are clinically being used for donor heart preservation include static controlled hypothermia and machine perfusion (MP) systems. Controlled hypothermia allows for a monitored cold storage between 4°C and 8°C. This simple technique seems to better preserve the donor heart when compared to ice, probably avoiding tissue injury due to sub-zero °C temperatures. MP platforms are divided in normothermic and hypothermic, and continuously perfuse the donor heart, reducing ischemic time, a well-known independent risk factor for mortality after HTx. Also, normothermic MP permits to evaluate marginal donor grafts, and could represent a safe and effective technique to expand the available donor pool. However, despite the increasing number of donor hearts preserved with these new approaches, whether these techniques could be considered superior to traditional CS still represents a matter of debate. The aim of this review is to summarize and critically assess the available clinical data on donor heart preservation strategies employed for HTx.
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Affiliation(s)
- Andrea Lechiancole
- Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale, University Hospital of Udine, Udine, Italy
| | - Sandro Sponga
- Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale, University Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Giovanni Benedetti
- Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale, University Hospital of Udine, Udine, Italy
| | - Arianna Semeraro
- Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale, University Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Giorgio Guzzi
- Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale, University Hospital of Udine, Udine, Italy
| | - Cristian Daffarra
- Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale, University Hospital of Udine, Udine, Italy
| | - Matteo Meneguzzi
- Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale, University Hospital of Udine, Udine, Italy
| | - Chiara Nalli
- Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale, University Hospital of Udine, Udine, Italy
| | - Daniela Piani
- Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale, University Hospital of Udine, Udine, Italy
| | - Marilyn Bressan
- Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale, University Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Ugolino Livi
- Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale, University Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Igor Vendramin
- Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale, University Hospital of Udine, Udine, Italy
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Multicenter Registry Using Propensity Score Analysis to Compare a Novel Transport/Preservation System to Traditional Means on Postoperative Hospital Outcomes and Costs for Heart Transplant Patients. ASAIO J 2022; 69:345-349. [PMID: 36399786 PMCID: PMC10045959 DOI: 10.1097/mat.0000000000001844] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The standard method for cardiac allograft preservation for the past 50 years has been static storage using crushed ice. A heart transplant transportation system designed to improve preservation quality with temperature monitoring, the Paragonix SherpaPak Cardiac Transport System (SCTS), was evaluated for its impact on postoperative costs relative to conventional ice storage. Observational US multicenter registry data collected during the August 2015 to November 2021 timeframe from 12 transplant hospitals were analyzed using logistic regression analysis and propensity matching to balance measured baseline covariates and to reduce selection bias. Hospital cost and outcome data post-transplant were then evaluated using various statistical methods. One hundred seventy-four (174) patients were identified resulting in 87 matches. Baseline characteristics were similar between groups. The SCTS group had a significantly lower proportion of ICU days on post-transplant mechanical circulatory support (p < 0.0001); significantly fewer patients on extracorporeal membrane oxygenation (p = 0.017); and significantly fewer patients experiencing severe primary graft dysfunction (PGD) (p = 0.03). Overall hospital plus mechanical circulatory support post-transplant costs were significantly lower by $26.7K in the CTS cohort (p = 0.03). Use of the SCTS is associated with improved clinical outcomes resulting in significantly lower overall hospital care costs.
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12
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Bitargil M, Haddad O, Pham SM, Garg N, Jacob S, El-Sayed Ahmed MM, Landolfo K, Patel PC, Goswami RM, Leoni Moreno JC, Yip DS, Sareyyupoglu B. Packing the donor heart: Is SherpaPak cold preservation technique safer compared to ice cold storage. Clin Transplant 2022; 36:e14707. [PMID: 35543679 DOI: 10.1111/ctr.14707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 04/27/2022] [Accepted: 05/03/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The present study aimed to compare the clinical outcomes of heart transplant patients whose donor hearts were preserved with the SherpaPak controlled cold organ system versus the conventional ice storage technique. METHODS All patients undergoing heart transplantation at our center between January 2019 and April 2021 were divided into two groups according to the technique used during donor heart preservation and transport. The first group consisted of 34 SherpaPak controlled temperature preservation patients, and the second group consisted of 47 patients where the conventional three bags and ice technique was utilized during organ transportation. The two groups were compared based on demographics, operative details, and postoperative outcomes. RESULTS There were no significant differences between the groups regarding Vasoactive Inotropic Score (VIS), Primary Graft Dysfunction (PGD), and the need for a transient pacer. However, the VIS, PGD, and pacing trends were lower in the SherpaPak patients even though the total ischemic and cardiopulmonary bypass times were significantly longer. Furthermore, SherpaPak patients exhibited a shorter stay in the ICU with no severe PGD and mortality. CONCLUSION The SherpaPak donor heart preservation provides safe outcomes in heart transplant patients. Further research is needed to utilize this method for longer durations of ischemic time and expand travel distances for organ transportation. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Macit Bitargil
- Mayo Clinic Hospital, Department of Cardiothoracic Surgery, Jacksonville, Florida, USA
| | - Osama Haddad
- Mayo Clinic Hospital, Department of Cardiothoracic Surgery, Jacksonville, Florida, USA
| | - Si M Pham
- Mayo Clinic Hospital, Department of Cardiothoracic Surgery, Jacksonville, Florida, USA
| | - Neha Garg
- Mayo Clinic Hospital, Department of Cardiothoracic Surgery, Jacksonville, Florida, USA
| | - Samuel Jacob
- Mayo Clinic Hospital, Department of Cardiothoracic Surgery, Jacksonville, Florida, USA
| | | | - Kevin Landolfo
- Mayo Clinic Hospital, Department of Cardiothoracic Surgery, Jacksonville, Florida, USA
| | - Parag C Patel
- Mayo Clinic Hospital, Department of Transplantation, Jacksonville, Florida, USA
| | - Rohan M Goswami
- Mayo Clinic Hospital, Department of Transplantation, Jacksonville, Florida, USA
| | | | - Daniel S Yip
- Mayo Clinic Hospital, Department of Transplantation, Jacksonville, Florida, USA
| | - Basar Sareyyupoglu
- Mayo Clinic Hospital, Department of Cardiothoracic Surgery, Jacksonville, Florida, USA
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13
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A Simple Technique for Reliable Donor Organ Temperature Management With the SherpaPak System. ASAIO J 2022; 68:e134-e135. [DOI: 10.1097/mat.0000000000001657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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14
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van Suylen V, Vandendriessche K, Neyrinck A, Nijhuis F, van der Plaats A, Verbeken EK, Vermeersch P, Meyns B, Mariani MA, Rega F, Erasmus ME. Oxygenated machine perfusion at room temperature as an alternative for static cold storage in porcine donor hearts. Artif Organs 2021; 46:246-258. [PMID: 34633676 PMCID: PMC9298357 DOI: 10.1111/aor.14085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 06/15/2021] [Accepted: 10/05/2021] [Indexed: 01/06/2023]
Abstract
Background There is a continued interest in ex situ heart perfusion as an alternative strategy for donor heart preservation. We hypothesize that oxygenated machine perfusion of donor hearts at a temperature that avoids both normothermia and deep hypothermia offers adequate and safe preservation. Methods Cardioplegia‐arrested porcine donor hearts were randomly assigned to six hours of preservation using cold storage (CS, n = 5) or machine perfusion using an oxygenated acellular perfusate at 21°C (MP, n = 5). Subsequently, all grafts were evaluated using the Langendorff method for 120 min. Metabolic parameters and histology were analyzed. Systolic function was assessed by contractility and elastance. Diastolic function was assessed by lusitropy and stiffness. Results For both groups, in vivo baseline and post‐Langendorff biopsies were comparable, as were lactate difference and myocardial oxygen consumption. Injury markers gradually increased and were comparable. Significant weight gain was seen in MP (p = 0.008). Diastolic function was not impaired in MP, and lusitropy was superior from 30 min up to 90 min of reperfusion. Contractility was superior in MP during the first hour of evaluation. Conclusion We conclude that the initial functional outcome of MP‐preserved hearts was transiently superior compared to CS, with no histological injury post‐Langendorff. Our machine perfusion strategy could offer feasible and safe storage of hearts prior to transplantation. Future studies are warranted for further optimization.
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Affiliation(s)
- Vincent van Suylen
- Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Arne Neyrinck
- Laboratory of Experimental Thoracic Surgery, Department of Clinical and Experimental Medicine, Catholic University Leuven, Leuven, Belgium.,Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Erik K Verbeken
- Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium.,Department of Histopathology, University Hospitals Leuven, Leuven, Belgium
| | - Pieter Vermeersch
- Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium.,Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Bart Meyns
- Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium.,Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Massimo A Mariani
- Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Filip Rega
- Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium.,Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Michiel E Erasmus
- Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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15
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Copeland H, Hayanga JA, Neyrinck A, MacDonald P, Dellgren G, Bertolotti A, Khuu T, Burrows F, Copeland JG, Gooch D, Hackmann A, Hormuth D, Kirk C, Linacre V, Lyster H, Marasco S, McGiffin D, Nair P, Rahmel A, Sasevich M, Schweiger M, Siddique A, Snyder TJ, Stansfield W, Tsui S, Orr Y, Uber P, Venkateswaran R, Kukreja J, Mulligan M. Donor heart and lung procurement: A consensus statement. J Heart Lung Transplant 2020; 39:501-517. [DOI: 10.1016/j.healun.2020.03.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 01/02/2023] Open
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16
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Vela RJ, Jessen ME, Peltz M. Ice, ice, maybe? Is it time to ditch the igloo cooler? Benefits of machine perfusion preservation of donor hearts. Artif Organs 2019; 44:220-227. [DOI: 10.1111/aor.13599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Ryan J. Vela
- Department of Cardiovascular and Thoracic Surgery University of Texas Southwestern Medical Center Dallas Texas
| | - Michael E. Jessen
- Department of Cardiovascular and Thoracic Surgery University of Texas Southwestern Medical Center Dallas Texas
| | - Matthias Peltz
- Department of Cardiovascular and Thoracic Surgery University of Texas Southwestern Medical Center Dallas Texas
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17
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Iyengar A, Atluri P. Commentary: Keeping your cool: Donor heart preservation using the SherpaPak Cardiac Transport System. J Thorac Cardiovasc Surg 2019; 159:e125-e126. [PMID: 31405590 DOI: 10.1016/j.jtcvs.2019.06.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 06/28/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Amit Iyengar
- Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Pavan Atluri
- Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa.
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18
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Glucose is an Ineffective Substrate for Preservation of Machine Perfused Donor Hearts. J Surg Res 2012; 173:198-205. [DOI: 10.1016/j.jss.2011.05.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Revised: 04/01/2011] [Accepted: 05/19/2011] [Indexed: 11/23/2022]
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19
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20
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Zhang S, Yang JH, Yu F, Zhao J, Jiang P, Chang L, Tang C, Xu J. Protective role of 3-nitro-N-methyl-salicylamide on isolated rat heart during 4 hours of cold storage and reperfusion. Transplant Proc 2006; 38:1247-52. [PMID: 16797274 DOI: 10.1016/j.transproceed.2006.02.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Cardiac ischemia/reperfusion (I/R) injury, a necessary consequence of transplantation, is probably related to the formation of reactive oxygen species (ROS). The ROS burst within the first moments of reperfusion is associated with injury, continuously generate O2- at about 3% to 5% of total O2 consumption owing to electron leak by mitochondrial oxidoreductases, especially complexes I and III. 3-nitro-N-methyl-salicylamide (NNMS) displays inhibitory effects on succinate-cytochrome C reductase, but also reduces effects on creation of O2- radical and H2O2 by isolated rat mitochondria. Presumably NNMS inhibits electron leakage from the mitochondrial respiratory chain. We investigated effect of NNMS on heart protection after hypothermic ischemia. METHODS A Langendorff-prepared rat heart model was employed after the heart had been preserved for 4 hours under hypothermic conditions of ischemia with subsequent reperfusion/rewarming for 60 minutes. RESULTS The group of hearts treated with NNMS showed increased recovery of heart function compared with a group of mEC. The lactate dehydrogenase (LDH) activity in coronary flow (CF) by hearts treated with NNMS was lower than that with mECs, as was the content of malonedialdehyde (MDA) and conjugated diene (CD). CONCLUSIONS NNMS improved heart physiology after reperfusion following 4 hours of hypothermic ischemia.
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Affiliation(s)
- S Zhang
- National Laboratory of Biomacromolecule, Center for Molecular Biology, Institute of Biophysics, Chinese Academy of Science, Beijing, China
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21
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Abstract
Heart and lung transplantation have become standard therapy for many patients with end-stage heart and lung disease. Successful transplantation requires preservation of allografts until they can be implanted and reperfused. In the decades since the transplantation of thoracic organs became a clinical reality, many advances have been made in preoperative donor management, procurement, and preservation techniques. This article summarizes the state of the art in heart and lung preservation and review some of the areas of current research that may lead to improvements in preservation techniques in the future.
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Affiliation(s)
- J V Conte
- Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA
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22
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Calhoon JH, Bunegin L, Gelineau JF, Felger MC, Naples JJ, Miller OL, Sako EY. Twelve-hour canine heart preservation with a simple, portable hypothermic organ perfusion device. Ann Thorac Surg 1996; 62:91-3. [PMID: 8678692 DOI: 10.1016/0003-4975(96)00272-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cardiac transplantation is limited to an ischemic time of around 6 hours by available preservation solution and technique. Complex organ preservation devices have been developed that extend this time to 24 hours or more, but are clinically impractical. This study evaluates a portable oxygen-driven organ perfusion device weighing approximately 13.5 kg. METHODS Organs are perfused with the University of Wisconsin solution at low perfusion pressure using less than 400 L of oxygen per 12 hours. Left ventricular parameters were measured in anesthetized adult beagles to establish control values (n = 5). Hearts were procured after cardioplegia with 4 degrees C University of Wisconsin solution, weighed, then stored for 12 hours in University of Wisconsin solution at 4 degrees C. Hearts were perfused (n = 3) or nonperfused (n = 2) during storage. Organ temperature, partial pressure of oxygen in the aorta and right atrium, perfusion pressure, and aortic flow were recorded hourly in perfused hearts. After 12 hours, hearts were transplanted into littermates and left ventricular parameters measured after stabilization off bypass. RESULTS Organ weight for both groups was unchanged. Nonperfused hearts required both pump and pharmacologic support with significantly depressed left ventricular function. Perfused hearts needed minimal pharmacologic support, with left ventricular end-diastolic pressure, cardiac output, and rate of change of left ventricular pressure showing no statistical difference from control. CONCLUSIONS These findings confirm the potential for extended metabolic support for ischemia-intolerant organs in a small, lightweight, easily portable preservation system.
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Affiliation(s)
- J H Calhoon
- Department of Surgery, University of Texas Health Science Center at San Antonio 78284-7841, USA
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Masters RG, Hendry PJ, Davies RA, Smith S, Struthers C, Walley VM, Veinot JP, Mussivand TV, Keon WJ. Cardiac transplantation after mechanical circulatory support: a Canadian perspective. Ann Thorac Surg 1996; 61:1734-9. [PMID: 8651776 DOI: 10.1016/0003-4975(96)00138-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND To assess the relative efficacy of cardiac transplantation after mechanical circulatory support with a variety of support systems, we analyzed our consecutive series of patients who had and did not have mechanical support before transplantation. METHODS A review of 209 patients undergoing cardiac transplantation from 1984 to May 1995 was performed. Group 1 consisted of 110 patients who were maintained on oral medications while awaiting transplantation, and group 2 consisted of 60 patients who required intravenous inotropic support. Group 3 included 39 patients who had transplantation after mechanical circulatory support for cardiogenic shock. The indication for device implantation was acute onset of cardiogenic shock in 38 patients and deterioration while awaiting transplantation in 1 patient. The support systems were an intraaortic balloon pump in 13 (subgroup 3A), a ventricular assist device in 7 (subgroup 3B), and a total artificial heart in 19 patients (subgroup 3C). RESULTS After transplantation, infection was more common in group 3 (56%) than in group 1 (28%) or group 2 (32%) (p = 0.005). Survival to discharge was lower for group 3 (71.7%) than for group 1 (90.9%) or 2 (88.3%) (p = 0.009). For mechanically supported patients, survival to discharge was 84.6% in subgroup 3A, 71.4% in subgroup 3B, and 63.1% in subgroup 3C (p = not significant). CONCLUSIONS Transplantation after mechanical support offers acceptable results in this group of patients for whom the only alternative is certain death. Patient selection and perioperative management remain the challenge to improving these results.
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Affiliation(s)
- R G Masters
- Division of Surgery, University of Ottawa Heart Institute, Ottawa Civic Hospital, Ontario, Canada
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24
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Daily PO, Adamson RM, Jones BH, Dembitsky WP, Moreno-Cabral RJ. Comparisons of methods of myocardial hypothermia for cardiac transplantation. Ann Thorac Surg 1996; 61:679-83. [PMID: 8572787 DOI: 10.1016/0003-4975(95)01091-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Myocardial hypothermia of less than 10 degrees C is an essential component of preservation of donor hearts before implantation. Here we report temperature changes and comparison of methods for maintenance of myocardial hypothermia during implantation. METHODS Twenty patients were prospectively randomized into two equal groups. In one cohort myocardial hypothermia was maintained by the "Stanford method" of continuous lavage of the pericardium and left atrium with refrigerated saline solution. In the other a cooling jacket was used without saline lavage. Temperatures at multiple sites were measured at 30-second intervals from initiation of cardiac suturing until aortic cross-clamp removal. Comparisons were made between groups at each temperature site. RESULTS The cooling jacket group temperatures were significantly lower at the left ventricular epicardium and endocardium than those of the Stanford method group. CONCLUSIONS During cardiac implantation maintenance of myocardial hypothermia with a cooling jacket resulted in significantly deeper and more consistent hypothermia of the left ventricle than pericardial and left atrial lavage with refrigerated saline solution. Blood loss from aspirated saline lavage and perfusate dilution by the saline solution were eliminated.
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Affiliation(s)
- P O Daily
- Sharp Memorial Hospital, San Diego, California, USA
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25
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Ibrahim M, Masters RG, Hendry PJ, Davies RA, Smith S, Struthers C, Walley VM, Keon WJ. Determinants of hospital survival after cardiac transplantation. Ann Thorac Surg 1995; 59:604-8. [PMID: 7887697 DOI: 10.1016/0003-4975(94)00955-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
To identify the preoperative factors that influence hospital survival after transplantation we analyzed our consecutive experience of 183 transplantations in 179 patients over a 10-year period. There were 151 male and 29 female transplant recipients ranging in age from 10 days to 70 years (mean, 48 +/- 1 years). Diagnoses included coronary disease in 110 patients, cardiomyopathy in 55 patients, valvular disease in 6 patients, and congenital heart disease in 9 patients. Seventy-seven had undergone a previous cardiac operation, and 30 patients required preoperative mechanical support. Forty patients received hearts from donors who were 40 years old or older (range, 40 to 62 years). Ischemic time was greater than 240 minutes in 32 cases, and pulmonary vascular resistance was greater than 3 Wood units in 40 patients (range, 3.1 to 10.0 Wood units). Cyclosporine induction was used in 52 patients, whereas 128 recipients received polyclonal antibody prophylaxis. There were 25 hospital deaths. Recipient diagnosis, use of mechanical support, donor age, and the immune suppression protocol were related to hospital survival according to univariate analysis. Using multiple logistic regression, only the method of immune suppression induction and the use of mechanical assists were significant independent determinants of survival. In conclusion, we believe that extended ischemic times and donor age do not adversely affect the early success of transplantation, whereas induction with immune globulin may reduce early mortality. Patients requiring mechanical support before transplantation continue to be a challenge.
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Affiliation(s)
- M Ibrahim
- University of Ottawa Heart Institute, Division of Cardiac Surgery, Ottawa Civic Hospital, Canada
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26
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Sundaresan S, Lima O, Date H, Matsumura A, Tsuji H, Obo H, Aoe M, Mizuta T, Cooper JD. Lung preservation with low-potassium dextran flush in a primate bilateral transplant model. Ann Thorac Surg 1993; 56:1129-35. [PMID: 7694553 DOI: 10.1016/0003-4975(95)90030-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We used a bilateral lung transplant model to confirm, in primates, the results of lung preservation studies previously obtained in a canine single-lung transplant model. The donor lungs were flushed with low-potassium dextran solution and maintained semiinflated with 100% oxygen at 10 degrees C for a planned ischemic time of 12 hours for the lung implanted first. Of eight experiments performed, results in the 6 operative survivors form the basis of this report. After bilateral lung transplantation, animals were maintained on a ventilator for 6 hours; arterial oxygen tension, pulmonary artery pressure, and pulmonary vascular resistance were determined in the recipients at 2, 4, and 6 hours after transplantation and compared with donor values, which served as controls. Arterial oxygen tension in the recipients did not differ from the controls (p = not significant), whereas the pulmonary artery pressure and pulmonary vascular resistance showed significant elevation (p < 0.05 versus control values). After the 6 hours of assessment, the animals were extubated and 3 survived for 48 to 72 hours with a mean arterial oxygen tension of 69 mm Hg on room air. These results demonstrate excellent lung function after a minimum of 12 hours of preservation in a primate model in which the animal is totally dependent on the function of transplanted lung tissue, and confirm the potential for prolonged clinical lung preservation.
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Affiliation(s)
- S Sundaresan
- Department of Surgery, Washington University School of Medicine, Barnes Hospital, St. Louis, Missouri 63110
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Hendry PJ, Keon WJ. Temperatures attained by donor hearts stored in ice during transport are not too cold: Reply to the Editor. J Thorac Cardiovasc Surg 1992. [DOI: 10.1016/s0022-5223(19)34759-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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29
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Cochrane A, Rosenfeldt F. Temperatures attained by donor hearts stored in ice during transport are not too cold. J Thorac Cardiovasc Surg 1992. [DOI: 10.1016/s0022-5223(19)34758-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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30
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Mayer E, Puskas JD, Cardoso PF, Shi S, Slutsky AS, Patterson GA. Reliable eighteen-hour lung preservation at 4° and 10° C by pulmonary artery flush after high-dose prostaglandin E1 administration. J Thorac Cardiovasc Surg 1992. [DOI: 10.1016/s0022-5223(19)34878-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Affiliation(s)
- L W Miller
- Department of Internal Medicine, St Louis University Medical Center, MO 63110
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