PERFUSION REHABILITATION OF A DONOR HEART FOLLOWING WARM ISCHEMIA: AN EXPERIMENTAL STUDY

Highlights

• Normothermic regional perfusion enables successful recovery of contractile function after 30 minutes of warm ischemia after circulatory death.
• Perfusion strategies targeting either a constant aortic root pressure (60–70 mmHg) or a constant systemic flow (100 mL/kg/min) yield comparable restoration of systolic and diastolic myocardial function, similar histological findings, and equivalent coronary sinus lactate levels.
• Flow‑targeted perfusion is associated with significantly higher systemic arterial pressure after weaning from cardiopulmonary bypass, suggesting more favourable early hemodynamic adaptation of the graft.

Background. The shortage of donor organs remains an unresolved issue in transplantology. Donation after circulatory death is a promising avenue for expanding the donor pool but requires optimization of perfusion resuscitation protocols for grafts subjected to warm ischemia.

Aim. To compare two strategies of normothermic regional perfusion – control of perfusion pressure (60–70 mmHg, group A) versus control of systemic flow (100 mL/kg/min, group B) – in an experimental DCD-donor model.

Methods. The experiment was performed on 10 Landrace pigs (aged 3–5 months). Circulatory arrest was induced by exsanguination followed by 30 minutes of warm ischemia. NRP was conducted for 30 minutes, after which animals were weaned from cardiopulmonary bypass. Hemodynamic parameters, echocardiographic indices of systolic and diastolic function, coronary sinus lactate levels, myocardial edema extent, and histological changes were assessed.

Results. Sinus rhythm was restored in all cases. After weaning from perfusion, group B demonstrated significantly higher systolic (107 vs. 61 mmHg, p = 0.036) and mean arterial pressure (92 vs. 71.5 mmHg, p = 0.041) compared to group A. No significant intergroup differences were found in cardiac output, echocardiographic parameters of ventricular function, lactate levels, edema extent, or myocardial histology.

Conclusion. Both studied NRP strategies effectively restore heart graft function after warm ischemia. Flow-targeted perfusion is associated with higher systemic arterial pressure in the early post-reperfusion period, which may be relevant for graft hemodynamic stability.

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