Myocardial oxygen handling and metabolic function of ex-situ perfused human hearts from circulatory death donors

• Published in: JHLT open 2024-11, Vol.6, p.100159, Article 100159
• Main Authors: Amesz, Jorik H., Langmuur, Sanne J.J., Bierhuizen, Mark F.A., Dumay, Dwight, van de Woestijne, Pieter C., Sjatskig, Jelena, Sluijter, Lisa E., Duncker, Dirk J., Manintveld, Olivier C., Taverne, Yannick J.H.J.
• Format: Article
• Language: English
• Subjects: cardiac transplantation; donation after circulatory death; ex-situ heart perfusion; myocardial oxygen consumption; normothermic machine perfusion
• ISSN: 2950-1334; 2950-1334
• DOI: 10.1016/j.jhlto.2024.100159

This study investigated oxygen handling of human hearts donated after circulatory death (DCD) on normothermic ex-situ heart perfusion (ESHP) and evaluated oxygen handling markers as adjuncts to cardiac viability assessment. This single-center retrospective study included human DCD heart transplantation procedures using ESHP. Lactate concentrations, blood gas, myocardial oxygen consumption (MVO2), delivery (MDO2), and extraction (MEO2), coronary blood flow (CBF), coronary vascular resistance (CVR), and adenosine infusion were reported over time. Correlation between parameters was assessed, and statistical testing compared patients who did and did not require extracorporeal membrane oxygenation (ECMO) support after transplantation. Lactate concentrations decreased during ESHP in all transplanted hearts (n = 25) and increased in 1 rejected heart. Arterial partial pressure of oxygen (PO2) was 75.2 ± 2.9 kPa, with an arteriovenous ΔPO2 of 44.8 ± 10.4 kPa. Oxygen saturation was 100% in most arterial and venous samples. Average MVO2 was 2.7 ± 0.6 ml/min/100 g myocardium, MDO2 98.5 ± 20.4 ml/min, and MEO2 8.6 ± 1.8%. Average CVR was 0.025 ± 0.006 mm Hg min/ml/100 g and increased over time. ΔPO2 correlated strongly with MVO2 (R = 0.797, p