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Abstract

Medicine

Coronary Angiography During Ex-Situ Heart Perfusion in a Porcine Model

Published: July 12th, 2024

DOI:

10.3791/66567

1Department of Cardiovascular Surgery, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, 2Laboratory of Preclinical Research, Department of Research and Innovation, Groupe Hospitalier Paris Saint Joseph, 3Inserm UMR S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, 4Department of Cardiology, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, 5Department of Pharmacology and Toxicology, AP-HP. University of Paris-Saclay, 6Department of Thoracic Surgery, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, 7Department of Cardiovascular Surgery, University Hospital of Angers, 8University of Paris Saclay

Abstract

Heart transplantation is the gold standard treatment for advanced heart failure. The procurement of extended criteria donors (ECD) increases due to the current organ shortage. Coronary angiography is recommended in ECD at risk for coronary artery disease but is not systematically performed. These hearts are, therefore, either declined for transplant or procured without screening for coronary artery disease. Coronary angiography during normothermic ex-situ heart perfusion (NESP) could be an interesting approach to enhance the rate of ECD procurement and to reduce the risk of primary graft failure in the absence of coronary angiography in ECD. The present protocol aims to provide material details along with optimal imaging views for coronary angiography during NESP. Reproducible angiographic views were observed, including one dedicated to the right coronary artery, two for the left anterior descending artery, two for the circumflex artery, and a spider view. Continuous lactate extraction was observed in all procedures with a final median concentration of 1.10 mmol/L (0.61-1.75 mmol/L) two hours after coronary angiography, consistent with myocardial viability. The median contrast agent volume used for ex-situ imaging of the isolated perfused heart was 48 mL (38-108 mL). This protocol was reproducible for coronary artery imaging and did not impair myocardial viability during NESP.

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