Thorac cardiovasc Surg
DOI: 10.1055/s-0036-1580604
Original Basic Science
Georg Thieme Verlag KG Stuttgart · New York

Large-Animal Biventricular Working Heart Perfusion System with Low Priming Volume—Comparison between in vivo and ex vivo Cardiac Function

Jan-Michael Abicht1, Tanja Axinja Jelena Mayr1, Judith Jauch1, Sonja Guethoff2, Stefan Buchholz2, Bruno Reichart3, Andreas Bauer1
  • 1Department of Anaesthesiology, Ludwig Maximilian University, Munich, Germany
  • 2Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
  • 3Walter Brendel Center, Ludwig Maximilian University, Munich, Germany
Further Information

Publication History

28 October 2015

24 January 2016

Publication Date:
04 April 2016 (eFirst)

Abstract

Background Existing large-animal, ex vivo, cardiac perfusion models are restricted in their ability to establish an ischemia/reperfusion condition as seen in cardiac surgery or transplantation. Other working heart systems only challenge one ventricle or require a substantially larger priming volume. We describe a novel biventricular cardiac perfusion system with reduced priming volume.

Methods Juvenile pig hearts were cardiopleged, explanted, and reperfused ex vivo after 150 minutes of cold ischemia. Autologous whole blood was used as perfusate (minimal priming volume 350 mL). After 15 minutes of Langendorff perfusion (LM), the system was switched into a biventricular working mode (WM) and studied for 3 hours.

Results During reperfusion, complete unloading of both ventricles and constant-pressure coronary perfusion was achieved. During working mode perfusion, the preload and afterload pressure of both ventricles was controlled within the targeted physiologic range. Functional parameters such as left ventricular work index were reduced in ex vivo working mode (in vivo: 787 ± 186 vs. 1 h WM 498 ± 66 mm Hg·mL/g·min; p < 0.01), but remained stable throughout the following study period (3 h WM 517 ± 103 mm Hg·mL/g·min; p = 0.63). Along with the elevated workload during WM, myocardial metabolism and oxygen consumption increased compared with LM (0.021 ± 0.08 vs. 0.06 ± 0.01 mL/min/g; 1 h after reperfusion). Histologic examination of the myocardium revealed no structural damage.

Conclusion In the ex vivo perfusion system, stable hemodynamic and metabolic conditions can be established for a period of 3 hours while functional and blood parameters are easily accessible. Moreover, because of the minimal priming volume, the novel ex vivo cardiac perfusion circuit allows for autologous perfusion, using the limited amount of blood available from the organ donating animal.