Development of machine perfusion for porcine donor hearts damaged by warm ischemia.

Burghgraef, T.A. (2013) Development of machine perfusion for porcine donor hearts damaged by warm ischemia. thesis, Medicine.

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Abstract

Introduction: Heart transplantation is the first choice of surgical treatment in patients with end-stage heart failure. However, the waiting list for cardiac transplantation is increasing since the mid-90’s, with a stabilization of the amount of transplants. A possibility to increase the donor pool would be by also using the deceased after cardiac death (DCD) donors, however with a warm ischemic period these organs are more affected by ischemia-reperfusion injury (IRI). The current preservation method; cold storage (CS), is not sufficient enough to preserve these hearts, therefore a perfusion apparatus needs to be developed for the perfusion preservation and warm oxygenated reperfusion. Materials & Methods: Hearts obtained from slaughter pigs were used as donors for setting up and testing parameters of the heart perfusion system during perfusion preservation (20°C) as well as during warm oxygenated reperfusion (37°C). Pressure, flow, temperature and oedema were measured during the perfusion preservation and during the warm oxygenated reperfusion period. The ability of resuscitating the heart and measuring the functionality of the heart was investigated in the warm oxygenated reperfusion model. Results: A procurement method has been developed which mimics the DCD donor procedure of hearts. Also a perfusion preservation machine has been designed for the perfusion preservation of the pig heart. However, this system was unable to reach and maintain a temperature of 20°C. A warm oxygenated reperfusion set-up has been designed for the controlled warm oxygenated reperfusion of the heart. However, we were not able to resuscitate the heart in this set up, and reach a (un) loaded state. High concentrations of potassium were measured in the porcine blood and warm oxygenated perfusion fluid. For the whole process of procurement, perfusion preservation and warm oxygenated reperfusion, protocols have been made. Conclusion: The procurement method mimics the DCD donor procedure of hearts quite well, the hearts might be useful for unloaded beating but not for functional measurements. Porcine blood should not be used for warm oxygenated reperfusion of the heart. Carefully obtained donor blood should be used, or an artificial oxygen carrier. The perfusion preservation apparatus is suitable for the heart; however a heat exchanger should be added to the system. We recommend doing the perfusion preservation with Steen at 20°C with a pressure of 40 mm Hg. The warm oxygenated reperfusion apparatus needs better isolation and a warm water bath in which the heart should immerse. We recommend to execute the warm oxygenated reperfusion with Steen and an oxygen carrier at 37°C with a pressure of 60 mm Hg.

Item Type:	Thesis (Thesis)
Supervisor name:	Erasmus, Dr M.E.
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:53
Last Modified:	25 Jun 2020 10:53
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1351

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