ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Robert S. Poston
Bartley P. Griffith
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Poston, R. S.
Right arrow Articles by Griffith, B. P.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Poston, R. S.
Right arrow Articles by Griffith, B. P.
Related Collections
Right arrow Transplantation - heart

Ann Thorac Surg 2004;78:1362-1370
© 2004 The Society of Thoracic Surgeons

Original article: cardiovascular

Optimizing Donor Heart Outcome After Prolonged Storage With Endothelial Function Analysis and Continuous Perfusion

Robert S. Poston, MDa,*, Junyan Gu, MD, PhDa, Deyanira Prastein, MDa, Fred Gage, PhDb, John W. Hoffman, BSa, Michael Kwon, BSa, Agnes Azimzadeh, PhDa, Richard N. Pierson, III, MDa, Bartley P. Griffith, MDa

a University of Maryland School of Medicine and Veterans Affairs Medical Center at Baltimore, Division of Cardiac Surgery, Baltimore, Maryland, USA
b Organ Recovery Systems, Inc, Des Plaines, Illinois, USA

Accepted for publication February 18, 2004.

* Address reprint requests to Dr Poston, Department of Surgery, Division of Cardiac Surgery, N4W94 22 S Greene St, Baltimore, MD, USA 21201
rposton{at}smail.umaryland.edu

Presented at the Fiftieth Annual Meeting of the Southern Thoracic Surgical Association, Bonita Springs, FL, Nov 13–15, 2003.

BACKGROUND: By minimizing tissue ischemia, continuous perfusion (CP) during organ transport may increase the safety of "marginal donors." My colleagues and I investigated whether an analysis of donor heart viability predicts recovery of grafts challenged with a 24-hour preservation interval.

METHODS: Dog hearts underwent cold static storage (CS) for 8 hours (n = 8) or 24 hours (n = 2) or CP for 24 hours with cold asanguinous, oxygenated solution (n = 8). Myocardial systolic and diastolic function and oxygen and lactate consumption were assessed at base line, during CP, and after Langendorff blood reperfusion. Base line endothelial function was evaluated by the percentage transcoronary change ([coronary sinus – aorta]/aorta) in myeloperoxidase and by platelet function and coronary flow reserve after 20 seconds of coronary artery occlusion. During CP, the endothelium was assessed by transcoronary protein release and coronary resistance. Edema was assessed by weight gain and histology.

RESULTS: Base line systolic and metabolic functions showed no relation to post-Langendorff function. Compared with CS, CP resulted in a greater recovery in systolic function (87% ± 35% vs 65% ± 15% of baseline; p = 0.05) and a shorter interval required for lactate consumption to exceed production (7.0 ± 6.8 minutes vs 15.0 ± 8.9 minutes; p = 0.06). Endothelial function was heterogeneous: coronary flow reserve, 2.7 ± 0.7; percentage change in myeloperoxidase, –8.4% ± 6.8%; and change in platelet function, 4.3% ± 3.5%, as determined by thromboelastography angle at base line. Protein release during CP for 24 hours was 8.3 ± 7.1 g. Two factors predicted more than 75% systolic pressure generation recovery: use of CP and normal endothelial function (p = 0.05; Fisher's exact test). However, CP led to edema according to histology, weight gain (72 ± 29 g), and impaired diastolic function versus CS (end-diastolic pressure-volume relationship, 1.4 ± 0.4 mm Hg/mL vs 0.8 ± 0.3 mm Hg/mL; p = 0.08).

CONCLUSIONS: Better systolic function despite 16 hours' more preservation than cold storage corroborates the idea that CP supports aerobic metabolism at physiologically important levels. Viability analysis focused on endothelial function and identified organs that were able to tolerate this 24-hour preservation interval.




This article has been cited by other articles:


Home page
 Eur. J. Cardiothorac. Surg.Home page
M. J. Collins, S. L. Moainie, B. P. Griffith, and R. S. Poston
Preserving and evaluating hearts with ex vivo machine perfusion: an avenue to improve early graft performance and expand the donor pool.
Eur. J. Cardiothorac. Surg., August 1, 2008; 34(2): 318 - 325.
[Abstract] [Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2004 by The Society of Thoracic Surgeons.