Name: Video: Normothermic Ex Situ Porcine Heart Perfusion and Coronary Angiography for Artery Assessment
Uploaded: 2024-07-12T13:30:00
Description: 45 Views. Normothermic Ex Situ Porcine Heart Perfusion and Coronary Angiography for Artery Assessment

normothermic ex situ porcine heart perfusion and coronary angiography for artery assessment

Coronary Artery Assessment During Ex-Situ Heart Perfusion

Heart transplantation is the gold standard therapy for advanced heart failure1,2. However, this treatment is limited by the current organ shortage, leading to increased allocation of extended criteria donors (ECD), who are more frequently exposed to coronary artery disease (CAD). Coronary angiography is recommended in France to prevent the risk of primary graft failure related to CAD if the donor&#39;s age is greater than 55 years or 45 years with two cardiovascular risk factors3. Even though coronary angiography increases the chances of graft acceptance by 9%, this procedure is performed in only 33% of cases in France4. Hearts from ECD at risk for CAD are therefore either declined for transplant or procured without screening for coronary artery disease.
The Organ Care System (OCS) is the only clinically available machine perfusion (MP) for Normothermic Ex-situ heart perfusion (NESP). This technology allows for longer preservation before transplantation by perfusing the donor heart with warm, oxygenated blood. Continuous metabolic assessment is performed during NESP by monitoring the lactate profile5. The efficacy and safety of NESP are now demonstrated by several studies, including a recent meta-analysis6,7,8. Performing coronary angiography during NESP would be of major interest to increase the probability of transplanting hearts from ECDs at risk for CAD.
Previously published experiences of ex-situ coronary angiography9,10,11 suggest that conventional views are not suitable due to the inverted position of the heart in the perfusion module. In addition, OCS components visible with X-rays may impair imaging findings. Lastly, the toxicity of contrast agents on the myocardium during isolated heart perfusion remains questionable. The present report aims to provide a safe and reproducible approach to performing coronary angiography during NESP.

Author Spotlight: Innovative Technique for Coronary Angiography in Marginal Donors

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

Normothermic Ex Situ Porcine Heart Perfusion and Coronary Angiography for Artery Assessment

normothermic-ex-situ-porcine-heart-perfusion-coronary-angiography-for

Research

JoVE Journal

Medicine

45 Views. Normothermic Ex Situ Porcine Heart Perfusion and Coronary Angiography for Artery Assessment

Video: Normothermic Ex Situ Porcine Heart Perfusion and Coronary Angiography for Artery Assessment

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.

Screening for coronary artery disease could increase the procurement of donor hearts with extended criteria. A protocol for performing reproducible coronary angiography during ex-situ heart perfusion is described herein in a porcine model.

Heart transplantation is the gold standard treatment for advanced heart failure. The procurement of extended criteria donors (ECD) increases due to the ...