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Lookup NU author(s): Susan Stamp, Dr Joaquim Majo, Professor John Dark, Dr Noel Carter, David Talbot
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Background: This study reports on the development of a novel method for achieving ex vivo reanimation of hearts from a porcine donation after circulatory death (DCD) model without the use of donor pretreatment.Methods: Porcine hearts (n = 23) were procured 10-29 min after confirmation of asystole. All hearts underwent initial flush with AQIX RS-I solution (London, UK). A 2-h preservation period followed: group 1 hearts (n1-n11) were preserved using static cold storage, group 2 hearts (n12-n17) were preserved using oxygenated, hypothermic machine perfusion (MP), and group 3 hearts (n18-n23) were subjected to retrograde oxygen persufflation. Reperfusion was performed on a Langendorff modification of a Model 33 Functional Circulation circuit. In hearts n16-n23, a dialysis circuit was incorporated into the circuit to facilitate removal of metabolites. The experimental protocol was allowed to follow an evolutionary course, with the aim of achieving greater success with reanimation.Results: In group 1 (static cold storage), 7 of the 11 hearts (63.6%) achieved reanimation on the ex vivo circuit. Two of the six hearts (33.3%) in group 2 (MP) were successfully reanimated. All the six hearts (100%) in group 3 (persufflation) were successfully reanimated. The period of sustained reanimation increased when dialysis was incorporated into the circuit with a maximum of 300 min.Conclusions: Porcine DCD hearts after 29 min of warm ischemia can be reanimated using the method described. A mechanism of reoxygenation (oxygenated MP or coronary sinus oxygen persufflation) during preservation appears mandatory for hearts from DCDs. Persufflation was associated with a higher probability of successful reanimation. Dialysis in the warm phase was useful in removing metabolites that could interfere with reanimation.
Author(s): Mownah OA, Khurram MA, Ray C, Kanwar A, Stamp S, Rees D, Brassil J, Majo J, Dark JH, Carter NM, Talbot D
Publication type: Article
Publication status: Published
Journal: Journal of Surgical Research
Year: 2014
Volume: 189
Issue: 2
Pages: 326-334
Print publication date: 28/02/2014
ISSN (print): 0022-4804
ISSN (electronic): 1095-8673
Publisher: Academic Press
URL: http://dx.doi.org/10.1016/j.jss.2014.02.041
DOI: 10.1016/j.jss.2014.02.041
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