Thorac Cardiovasc Surg 2015; 63 - ePP44
DOI: 10.1055/s-0035-1544540

Twelve Hour Hypothermic Machine Perfusion for Donor Heart Preservation Leads to Improved Ultrastructural Characteristics Compared to Conventional Cold Storage

S. Michel 1, 2, Muraglia G.M. La II2, M.L. L. Madariaga 2, J. S. Titus 3, M. K. Selig 4, E. A. Farkash 4, J. S. Allan 2, L. M. Anderson 5, J. C. Madsen 2
  • 1Ludwig-Maximilians-Universität München, Herzchirurgische Klinik, München, Germany
  • 2Transplantation Biology Research Center, Massachusetts General Hospital, Boston, Massachusetts, United States
  • 3Department of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States
  • 4Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, United States
  • 5Paragonix Technologies, Braintree, United States

Objectives: Hypothermic machine perfusion of donor hearts enables continuous aerobic metabolism and washout of toxic metabolic byproducts. We evaluated the effect of machine perfusion on cardiac myocyte integrity in hearts preserved for 12 hours in a novel device that provides pulsatile oxygenated hypothermic perfusion (Paragonix Sherpa Perfusion™ Cardiac Transport System).

Methods: Pig hearts were harvested and stored in Celsior® solution for 12 hours using either conventional cold storage on ice (12h CS, n = 3) or pulsatile perfusion with different flow rates (12h PP, n = 3 or 12h PP low flow, n = 2). After cold preservation, hearts were reperfused using a non-working heart Langendorff system. Controls (n = 3) were reperfused immediately after organ harvest. Biopsies were taken from the apex of the left ventricle before storage, after storage and after reperfusion to measure ATP and Endothelin-1 content in the tissue. TUNEL-staining for signs of apoptosis and ultra-structural analysis using electron microscopy was performed.

Results: 12h PP hearts showed significantly more weight gain than 12h CS and controls after preservation, but not after reperfusion. Pulsatile perfused hearts showed less ATP depletion, lower Endothelin-1 levels and less apoptosis after preservation compared with CS. Electron microscopy revealed endothelial cell rupture, damaged muscle fibers and injury of mitochondria in the 12h CS group after reperfusion while the cell structures were preserved in the 12h PP group.

Conclusions: Hypothermic pulsatile perfusion of donor hearts leads to a better preserved cell structure compared with the conventional cold storage method for extended storage times. Perfusion techniques may therefore enable longer preservation times of donor hearts without a higher risk of primary graft failure after orthotopic heart transplantation.