1. Preservation by cold storage vs ex vivo normothermic perfusion of marginal donor hearts: clinical, histopathologic, and ultrastructural features.
- Author
-
Sponga S, Bonetti A, Ferrara V, Beltrami AP, Isola M, Vendramin I, Finato N, Ortolani F, and Livi U
- Subjects
- Adolescent, Adult, Child, Cryopreservation methods, Extracorporeal Circulation, Female, Follow-Up Studies, Heart, Heart Failure diagnosis, Heart Failure physiopathology, Heart Failure surgery, Humans, Male, Middle Aged, Retrospective Studies, Stroke Volume physiology, Temperature, Tissue Donors, Young Adult, Cryopreservation instrumentation, Heart Transplantation methods, Microscopy, Electron, Transmission methods, Myocardium ultrastructure, Organ Preservation methods, Perfusion methods, Ventricular Function, Left physiology
- Abstract
Background: The aim of this study was to match clinical outcomes of heart transplantation (HTx) against histopathologic and ultrastructural characteristics of marginal grafts preserved by cold storage (CS) or ex vivo normothermic perfusion., Methods: Since 2011, 100 patients had undergone HTx at our institution by using marginal donors (aged ≥55 years, expected ischemic time of >4 hours, left ventricular ejection fraction of ≤50%, interventricular septum thickness of ≥14 mm, drug abuse history, episodes of cardiac arrest, and presence of mild coronary artery disease). CS was utilized in 79 cases (Group 1, 79%), and ex vivo perfusion was utilized in 21 (Group 2, 21%). Pre-operative data, survival, and complications in the first 5 years after HTx were analyzed. Myocardial biopsies were collected at graft harvesting, just before implantation, and immediately after aortic declamping., Results: Pre-operative demographics were similar in the 2 groups. Graft utilization rate with ex vivo perfusion was 81%. Ischemic, cardiopulmonary bypass, and surgical times were shorter in Group 2 patients, who showed a lower incidence of overall complications (33% vs 13%, p = 0.04) and better 5-year survival (log-rank, p = 0.04). Moreover, restoration of hypertrophy-related sarcomere changes and mitigation of reperfusion-dependent myocardium injuries were more frequently observed in Group 2 hearts., Conclusions: Ex vivo perfusion allows for continuous evaluation of marginal donor hearts, favoring exclusion of unsuitable grafts, reduction of complications, and optimal survival of up to 5 years. Such results, supported by consistent histopathologic and ultrastructural findings, suggest better myocardial preservation., (Copyright © 2020 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF