Abstract
Purpose
Ischemic myocardial contracture (IMC) or “stone heart” is a condition with rapid onset following circulatory death. It inhibits transplantability of hearts donated upon circulatory death (DCD). We investigate the effectiveness of hemodynamic normalization upon withdrawal of life-sustaining therapy (WLST) in a large-animal controlled DCD model, with the hypothesis that reduction in cardiac work delays the onset of IMC.
Methods
A large-animal study was conducted comprising of a control group (\documentclass[12pt]{minimal}
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\begin{document}$$n=6$$\end{document}n=6) receiving no therapy upon WLST, and a test group (\documentclass[12pt]{minimal}
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\begin{document}$$n=6$$\end{document}n=6) subjected to a protocol for fully automated computer-controlled hemodynamic drug administration. Onset of IMC within 1 h following circulatory death defined the primary end-point. Cardiac work estimates based on pressure-volume loop concepts were developed and used to provide insight into the effectiveness of the proposed computer-controlled therapy.
Results
No test group individual developed IMC within \documentclass[12pt]{minimal}
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\begin{document}$${1} \text { h}$$\end{document}1h, whereas all control group individuals did (4/6 within \documentclass[12pt]{minimal}
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\begin{document}$${30}{\text { min}}$$\end{document}30min).
Conclusion
Automatic dosing of hemodynamic drugs in the controlled DCD context has the potential to prevent onset of IMC up to \documentclass[12pt]{minimal}
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\begin{document}$${1}{\text { h}}$$\end{document}1h, enabling ethical and medically safe organ procurement. This has the potential to increase the use of DCD heart transplantation, which has been widely recognized as a means of meeting the growing demand for donor hearts.
Supplementary Information
The online version contains supplementary material available at 10.1007/s13239-021-00537-8.
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