Name: large-animal model of donation after circulatory death and normothermic regional perfusion for cardiac assessment
Uploaded: 2022-05-10T16:00:00
Description: Watch this Scientific Journal Video about Large-Animal Model of Donation after Circulatory Death and Normothermic Regional Perfusion for Cardiac Assessment at JoVE.com

We would like to thank Melanie Borie, Caroline Landry, Henry Aceros and Ahmed Menaouar for their precious help and support.

The institutional animal care and use committee of the Centre de Recherche du Centre Hospitalier de l&#39;Universit&#233; de Montr&#233;al (CRCHUM) approved all experimental protocols, and animals were treated in compliance with the Guide for the Care and Use of Laboratory Animals. For this protocol, 3-4-month-old Large White male or female pigs weighing 50-60 kg was used. Animal size can vary according to the investigators&#39; experimental goals.
1. Animal preparation and anesthetic in...

<ol>
	<li>Yusen, R. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Registry+of+the+International+Society+for+Heart+and+Lung+Transplantation:+thirty-third+adult+heart+transplantation+report-2016;+focus+theme:+primary+diagnostic+indications+for+transplant.">The Registry of the International Society for Heart and Lung Transplantation: thirty-third adult heart transplantation report-2016; focus theme: primary diagnostic indications for transplant.</a> The Journal of Heart and Lung Transplantation: the Official Publication of the International Society for Heart Transplantation. 35 (10), 1170-1184 (2016).</li><li>Hornby, K., Ross, H., Keshavjee, S., Rao, V., Shemie, S. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Non-utilization+of+hearts+and+lungs+after+consent+for+donation:+a+Canadian+multicentre+study.">Non-utilization of hearts and lungs after consent for donation: a Canadian multicentre study.</a> Canadian Journal of Anaesthesia. 53 (8), 831-837 (2006).</li><li>Messer, S. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Functional+assessment+and+transplantation+of+the+donor+heart+after+circulatory+death.">Functional assessment and transplantation of the donor heart after circulatory death.</a> The Journal of Heart and Lung Transplantation: the Official Publication of the International Society for Heart Transplantation. 35 (12), 1443-1452 (2016).</li><li>Messer, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Outcome+after+heart+transplantation+from+donation+after+circulatory-determined+death+donors.">Outcome after heart transplantation from donation after circulatory-determined death donors.</a> The Journal of Heart and Lung Transplantation: the Official Publication of the International Society for Heart Transplantation. 36 (12), 1311-1318 (2017).</li><li>Dhital, K. K., Chew, H. C., Macdonald, P. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Donation+after+circulatory+death+heart+transplantation.">Donation after circulatory death heart transplantation.</a> Current Opinion in Organ Transplantation. 22 (3), 189-197 (2017).</li><li>Ardehali, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ex-vivo+perfusion+of+donor+hearts+for+human+heart+transplantation+(PROCEED+II):+a+prospective,+open-label,+multicentre,+randomised+non-inferiority+trial.">Ex-vivo perfusion of donor hearts for human heart transplantation (PROCEED II): a prospective, open-label, multicentre, randomised non-inferiority trial.</a> The Lancet. 385 (9987), 2577-2584 (2015).</li><li>White, C. W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessment+of+donor+heart+viability+during+ex+vivo+heart+perfusion.">Assessment of donor heart viability during ex vivo heart perfusion.</a> Canadian Journal of Physiology and Pharmacology. 93 (10), 893-901 (2015).</li><li>Xin, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+new+multi-mode+perfusion+system+for+ex+vivo+heart+perfusion+study.">A new multi-mode perfusion system for ex vivo heart perfusion study.</a> Journal of Medical Systems. 42 (2), 25 (2017).</li><li>Robinson, N., et al., Iaizzo, P. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Handbook of Cardiac Anatomy, Physiology, and Devices. , 469-491 (2015).</li><li>Swindle, M. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Swine in the Laboratory: Surgery, Anesthesia, Imaging, and Experimental Techniques. , (2007).</li><li>Nasir, B. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=HSP90+inhibitor+improves+lung+protection+in+porcine+model+of+donation+after+circulatory+arrest.">HSP90 inhibitor improves lung protection in porcine model of donation after circulatory arrest.</a> The Annals of Thoracic Surgery. 110 (6), 1861-1868 (2020).</li><li>Aceros, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Novel+heat+shock+protein+90+inhibitor+improves+cardiac+recovery+in+a+rodent+model+of+donation+after+circulatory+death.">Novel heat shock protein 90 inhibitor improves cardiac recovery in a rodent model of donation after circulatory death.</a> The Journal of Thoracic and Cardiovascular Surgery. 163 (2), 187-197 (2022).</li><li>Der Sarkissian, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Heat+shock+protein+90+inhibition+and+multi-target+approach+to+maximize+cardioprotection+in+ischaemic+injury.">Heat shock protein 90 inhibition and multi-target approach to maximize cardioprotection in ischaemic injury.</a> British Journal of Pharmacology. 177 (15), 3378-3388 (2020).</li><li>Aceros, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Celastrol-type+HSP90+modulators+allow+for+potent+cardioprotective+effects.">Celastrol-type HSP90 modulators allow for potent cardioprotective effects.</a> Life Sciences. 227, 8-19 (2019).</li><li>Aceros, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pre-clinical+model+of+cardiac+donation+after+circulatory+death.">Pre-clinical model of cardiac donation after circulatory death.</a> Journal of Visualized Experiments. (150), e59789 (2019).</li><li>Der Sarkissian, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Celastrol+protects+ischaemic+myocardium+through+a+heat+shock+response+with+up-regulation+of+haeme+oxygenase-1.">Celastrol protects ischaemic myocardium through a heat shock response with up-regulation of haeme oxygenase-1.</a> British Journal of Pharmacology. 171 (23), 5265-5279 (2014).</li></ol>

This manuscript describes a large-animal model donation after circulatory death (DCD) followed by thoracoabdominal normothermic regional perfusion. In this experiment, the heart is reperfused for a minimum of 30 min and a maximum of 3 h before it is weaned off from the ECMO circuit. The heart is then functioning on its own for 2 h which allows for valuable cardiac assessment on the short term. Therefore, the major limitation of this protocol is the short-term follow-up; however, a long-term assessment would be resource-i...

Over 300,000 individuals die in North America each year of heart failure (HF); cardiac transplantation remains the only treatment option for some of these patients with end stage disease1. Historically, the exclusive source for heart transplantation was donor hearts obtained after neurological determination of death (NDD), but even then, only around 40% were adequate for transplantation2. Between 15% to 20% of patients die while waiting for a heart donation, with shortage of donor hearts being one of the reasons that creates a discrepancy between the hearts available and the hearts needed2. In order to increase the organ donor pool, one important consideration is the use of hearts donated after circulatory death (DCD)3. There is reluctance to use DCD hearts because these organs are invariably submitted to a period of unprotected (warm) ischemia after cessation of blood circulation and may sustain irreversible damage. Although reports for successful DCD heart transplantation with excellent early outcomes do exist4,5, there is a need to develop a validated assessment method to determine if these hearts are usable and to potentially predict their post-transplant performance6,7. To limit ischemic periods of DCD hearts and to continuously monitor them during storage and transportation, ex situ heart perfusion systems were developed8. However, this technology relies on complex machines with perfusion equipment, and has a high upfront cost without any guarantee that the procured organ will be suitable for transplantation. A novel protocol for DCD heart transplantation based on normothermic regional perfusion (NRP) was proposed by Messer et al3. This technique involves restoring myocardial perfusion while the heart is still in the donor and excluding cerebral circulation. It allows a functional assessment in situ before procurement3.
When using large-animal models, the porcine heart is one of the preferred platforms to perform cardiac surgical research considering its anatomical similarity to the human heart. However, some important factors in porcine hearts should be considered when using this model. For example, porcine cardiac tissue is very fragile and friable and is prone to tears, especially in the pulmonary artery and the right atrium9. Another important factor to consider is that the porcine heart is very sensitive to ischemia and prone to arrhythmias, which is why antiarrhythmics should be administered routinely to every animal before the experiment; nevertheless, it is still considered an appropriate model for the study of acute ischemia in heart transplantation9.
This manuscript describes a large-animal (porcine) model of donation after circulatory death followed by thoracoabdominal normothermic regional perfusion that closely simulates the clinical scenario in heart transplantation and has the potential to facilitate novel therapeutic studies and strategies for translational research.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Amiodarone</td>
			<td></td>
			<td></td>
			<td>As available in the institution</td>
		</tr>
		<tr>
			<td>Angiocath 20G</td>
			<td>BD</td>
			<td>381704</td>
			<td></td>
		</tr>
		<tr>
			<td>Atropine 0.4 mg/mL</td>
			<td></td>
			<td></td>
			<td>As available in the institution</td>
		</tr>
		<tr>
			<td>Biomedicus Centrifugal Pump</td>
			<td>Medtronic</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Cardioplegia Solution (Del Nido)</td>
			<td>in-house made</td>
			<td></td>
			<td>Another solution can be used at the discretion of the researcher</td>
		</tr>
		<tr>
			<td>Cautery Pencil</td>
			<td>Covidien</td>
			<td>E2515H</td>
			<td></td>
		</tr>
		<tr>
			<td>Central Venous Catheter double-lumen</td>
			<td>Cook Medical</td>
			<td>C-UDLM-501J-LSC</td>
			<td></td>
		</tr>
		<tr>
			<td>Central Venous Sheath Introducer 7 Fr</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Conductance Catheter</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>CPB pack</td>
			<td>Medtronic</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>DLP Aortic Root Cannula</td>
			<td>Medtronic</td>
			<td>12218</td>
			<td></td>
		</tr>
		<tr>
			<td>DLP double-stage venous cannula (29 or 37 F)</td>
			<td>Medtronic</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Dobutamine</td>
			<td></td>
			<td></td>
			<td>As available in the institution</td>
		</tr>
		<tr>
			<td>Dopamine</td>
			<td></td>
			<td></td>
			<td>As available in the institution</td>
		</tr>
		<tr>
			<td>Electrode Polyhesive</td>
			<td>Covidien</td>
			<td>E7507</td>
			<td></td>
		</tr>
		<tr>
			<td>EOPA Arterial Cannula (17 or 21 F)</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Epinephrine</td>
			<td></td>
			<td></td>
			<td>As available in the institution</td>
		</tr>
		<tr>
			<td>O2 Face Mask</td>
			<td></td>
			<td></td>
			<td>As available in the institution</td>
		</tr>
		<tr>
			<td>Gloves, Nitrile, Medium</td>
			<td>Fischer</td>
			<td>27-058-52</td>
			<td></td>
		</tr>
		<tr>
			<td>Heparin 1000 IU/mL</td>
			<td></td>
			<td></td>
			<td>As available in the institution</td>
		</tr>
		<tr>
			<td>Inhaled Isofurane</td>
			<td></td>
			<td></td>
			<td>Provided by the institution&#39;s animal facility</td>
		</tr>
		<tr>
			<td>Jelco 16 or 18 G catheter</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Ketamine inj. 50 mL vial (100 mg/mL)</td>
			<td>Health Canada</td>
			<td></td>
			<td>Health Canada approval is required</td>
		</tr>
		<tr>
			<td>Lidocaine/Xylocaine 1%</td>
			<td></td>
			<td></td>
			<td>As available in the institution</td>
		</tr>
		<tr>
			<td>Magnesium Sulfate 5 g/10 mL</td>
			<td></td>
			<td></td>
			<td>As available in the institution</td>
		</tr>
		<tr>
			<td>Midazolam inj. 10 mL vial (5 mg/mL)</td>
			<td>Health Canada</td>
			<td></td>
			<td>Health Canada approval is required</td>
		</tr>
		<tr>
			<td>MPS Quest delivery disposable pack</td>
			<td>Quest Medical</td>
			<td>5001102-AS</td>
			<td></td>
		</tr>
		<tr>
			<td>Norepinephrine</td>
			<td></td>
			<td></td>
			<td>As available in the institution</td>
		</tr>
		<tr>
			<td>Normal Saline (NaCl 0.9%) 1L bag</td>
			<td>Baxter</td>
			<td>JB1324</td>
			<td></td>
		</tr>
		<tr>
			<td>Pipette Tips 1 mL</td>
			<td>Fisherbrand</td>
			<td>02-707-405</td>
			<td></td>
		</tr>
		<tr>
			<td>Propofol 1 mg/mL</td>
			<td></td>
			<td></td>
			<td>As available in the institution</td>
		</tr>
		<tr>
			<td>Rocuronium</td>
			<td></td>
			<td></td>
			<td>As available in the institution</td>
		</tr>
		<tr>
			<td>Set Admin Prim NF PB W/ Checkvalve</td>
			<td>Smith Medical</td>
			<td>21-0442-25</td>
			<td></td>
		</tr>
		<tr>
			<td>Sodium Bicarbonate (NaOH) 8.4%</td>
			<td></td>
			<td></td>
			<td>As available in the institution</td>
		</tr>
		<tr>
			<td>Sofsil 0 wax coated</td>
			<td>Covidien</td>
			<td>S316</td>
			<td></td>
		</tr>
		<tr>
			<td>Solumedrol 500 mg/5 mL</td>
			<td></td>
			<td></td>
			<td>As available in the institution</td>
		</tr>
		<tr>
			<td>Suction Tip</td>
			<td>Covidien</td>
			<td>8888501023</td>
			<td></td>
		</tr>
		<tr>
			<td>Suction Tubing 1/4&#39;&#39; x 120&#39;&#39;</td>
			<td>Med-Rx</td>
			<td>70-8120</td>
			<td></td>
		</tr>
		<tr>
			<td>Suture 3.0 Prolene Blu M SH</td>
			<td>Ethicon</td>
			<td>8523H</td>
			<td></td>
		</tr>
		<tr>
			<td>Suture 5.0 Prolene BB</td>
			<td>Ethicon</td>
			<td>8580H</td>
			<td></td>
		</tr>
		<tr>
			<td>Suture Prolene Blum 4-0 SH 36</td>
			<td>Ethicon</td>
			<td>8521H</td>
			<td></td>
		</tr>
		<tr>
			<td>Suture BB 4.0 Prolene</td>
			<td>Ethicon</td>
			<td>8881H</td>
			<td></td>
		</tr>
		<tr>
			<td>Tracheal Tube, 6.5 mm</td>
			<td>Mallinckrodt</td>
			<td>86449</td>
			<td></td>
		</tr>
		<tr>
			<td>Vasopressin</td>
			<td></td>
			<td></td>
			<td>As available in the institution</td>
		</tr>
	</tbody>
</table>

large-animal model of donation after circulatory death and normothermic regional perfusion for cardiac assessment

The increase in demand for cardiac transplantation throughout the years has fueled interest in donation after circulatory death (DCD) to expand the organ donor pool. However, the DCD process is associated with the risk of cardiac tissue injury due to the inevitable period of warm ischemia. Normothermic regional perfusion (NRP) allows for an in situ organ assessment, allowing the procurement of hearts determined to be viable. Here, we describe a clinically relevant large-animal model of DCD followed by NRP. Circulatory death is established in anesthetized pigs by stopping mechanical ventilation. After a preset warm ischemia period, an extracorporeal membrane oxygenator (ECMO) is used for a NRP period lasting at least 30 min. During this reperfusion period, the model allows the collection of various myocardial biopsies and blood samples for initial cardiac evaluation. Once NRP is weaned, biochemical, hemodynamic, and echocardiographic assessments of cardiac function and metabolism can be performed before organ procurement. This protocol closely simulates the clinical scenario previously described for DCD and NRP in heart transplantation and has the potential to facilitate studies aimed at decreasing ischemia-reperfusion injury and enhance cardiac functional preservation and recovery.

This preclinical model has been successfully used in our institution for multiple experiments. First, we demonstrated that DCD hearts, initially reperfused with NRP, demonstrated similar functional recovery following transplantation when compared to conventional beating heart donation preserved with cold storage. Further, we have used this protocol to show that cardiac functional assessment following NRP was predictive of post-transplantation recovery. Finally, we have also studied the effects of NRP on cerebral perfusio...

Watch this Scientific Journal Video about Large-Animal Model of Donation after Circulatory Death and Normothermic Regional Perfusion for Cardiac Assessment at JoVE.com

Large-Animal Model of Donation after Circulatory Death and Normothermic Regional Perfusion for Cardiac Assessment

The protocol describes a large-animal (porcine) model of donation after circulatory death, followed by thoracoabdominal normothermic regional perfusion that closely simulates the clinical scenario in heart transplantation, and has the potential to facilitate therapeutic studies and strategies.

The increase in demand for cardiac transplantation throughout the years has fueled interest in donation after circulatory death (DCD) to expand the organ ...

Este protocolo descreve um modelo animal de grande porte de doação após morte circulatória seguida de perfusão regional normotérmica toracoabdominal que mimetiza com precisão o transplante cardíaco clínico. Isso poderia ser usado para avaliar potenciais estratégias em pesquisa translacional. A principal vantagem deste protocolo é que ele fornece um modelo pré-clínico adequado para transplante cardíaco, dadas as semelhanças das técnicas anatômicas e cirúrgicas entre os corações suínos suínos e humanos.Comece usando uma caneta cauterizada para realizar uma incisão na linha média em um animal anestesiado da região cervical média até o xifoide. Em seguida, divida a gordura subcutânea, camada por camada, ao longo da linha média, utilizando eletrocautério para alcançar o peresterno. Depois de cortar ao redor da fúrcula esternal, use um dedo para retrair e varrer os tecidos moles sob o esterno.Abra o esterno com uma serra óssea, garantindo que o esterno esteja completamente dividido, tendo cuidado com a veia abaixo da parte superior do osso esternal. Em seguida, cauterizar o esterno ou aplicar cera de osso para garantir hemostasia adequada. Em seguida, com o uso do eletrocautério, dissecar e remover o timo, levantando-o do pericárdio e cauterizar os vasos que irrigam o timo da aorta e da veia cava superior para evitar sangramento.Cortar cuidadosamente o pericárdio aberto com cautério. Durante o corte, insira os dedos sob o pericárdio para evitar lesões no coração. Em seguida, administrar 300 unidades por quilograma de heparina por via intravenosa para obter anticoagulação sistêmica.Se o teste estiver disponível, verifique se o tempo de coagulação ativado é superior a 300 segundos. Administrar um bolus de três miligramas por quilograma de propofol por via intravenosa. Em seguida, interrompa a ventilação mecânica e desconecte o tubo endotraqueal.Monitorar a pressão arterial e a saturação periférica de oxigênio. Quando a pressão sistólica for inferior a 50 milímetros de mercúrio, inicie o tempo de isquemia quente funcional. Estabelecer parada circulatória quando houver assistolia e ausência de pulsatilidade arterial.Após a suspensão das terapias de manutenção da vida e confirmação do óbito, retrair inferiormente a via de saída do ventrículo direito, a artéria pulmonar à esquerda e a aorta à direita. Em seguida, dissecar cuidadosamente o espaço pulmonar da aorta com uso de cautério. Aplicar uma pinça cruzada grande sobre os vasos supra-aórticos para evitar e excluir a perfusão cerebral.Em seguida, com a pinça de Metzenbaum e ângulo reto, dissecar delicadamente entre a veia cava superior e a artéria inominada e entre a veia cava inferior e o pericárdio. Circundar as veias cavas superior e inferior com fita umbilical ou sutura simples de seda zero e fixá-las com torniquete. Com sutura 3-0, colocar dois fios concêntricos em bolsa na adventícia da aorta ascendente distal, evitando pontos de espessura total.Em seguida, coloque uma sutura em bolsa no átrio direito antes de fixar todas as suturas com um torniquete. Em seguida, montar e acionar o sistema de perfusão regional normotérmico. Em seguida, canular a aorta com cânula arterial francesa de 17 a 21 e fixá-la no lugar apertando o torniquete, segurando a sutura em bolsa.Crie uma incisão de cinco milímetros no centro da corda da bolsa no átrio direito e dilate-a usando um pequeno instrumento angulado, como um ângulo reto ou estalo. Cubra a incisão com um dedo para evitar sangramento excessivo. Em seguida, utilizar cânula venosa de duplo estágio para canular o átrio direito.Em seguida, prenda a cânula apertando as suturas da bolsa com torniquete. Conecte as cânulas à linha venosa do circuito de perfusão regional normotérmico usando um conector de meia a três sobre oito polegadas, garantindo a desarejamento completa para evitar um bloqueio de ar no sistema. Garantir que tenha decorrido um mínimo de 15 minutos entre a declaração de óbito e o início da perfusão regional normotérmica para abranger o tempo necessário no preparo da prática clínica, no drapeamento e no acesso ao coração.15 minutos após o início do tempo de isquemia quente funcional, iniciar a perfusão regional normotérmica e ajustar progressivamente as taxas de fluxo para atingir um índice de perfusão de 2,5 litros por minuto por metro quadrado. Reinicie a ventilação mecânica com uma fração inspirada de 50% de oxigênio e seis mililitros por quilograma de volume corrente. Quando os critérios de desmame forem atendidos, interrompa a perfusão regional normotérmica.Retire a cânula do átrio direito e aperte rapidamente a sutura em bolsa para minimizar a perda de sangue. Fixar a sutura com nós. Em seguida, siga o mesmo procedimento para remover a cânula aórtica.Analise a função cardíaca através da ecocardiografia utilizando uma sonda transesofágica padrão e uma sonda transtorácica colocada diretamente sobre o coração. Resultados representativos da função cardíaca demonstraram um declínio significativo da função cardíaca após a doação após morte circulatória. Entretanto, esses órgãos demonstraram recuperação funcional semelhante após o transplante quando comparados aos corações transplantados convencionalmente.As medidas de oximetria cerebral durante a perfusão regional normotérmica com os vasos supra-aórticos pinçados confirmaram a ausência de perfusão cerebral adequada, enquanto as medidas de complacência pulmonar durante a perfusão regional normotérmica e após o desmame do suporte não mostraram alteração significativa em relação aos valores basais. O desenvolvimento dessa técnica introduziu a importância de avaliar a transplantabilidade de outros órgãos, como pulmões, rins e fígado, no contexto da doação após morte circulatória e perfusão regional normotérmica.

Research

JoVE Journal

Medicine

Normothermic Cardiac Arrest and Cardiopulmonary Resuscitation: A Mouse Model of Ischemia-Reperfusion Injury

Cardiac Arrest normotérmica e Ressuscitação Cardiopulmonar: um modelo do rato de isquemia-reperfusão

Acute Kidney Injury (AKI) is a common, highly lethal, complication of critical illness which has a high mortality1-4 and which is most 
frequently caused ...

Medicina

Ex Situ Normothermic Machine Perfusion of Donor Livers

Ex Situ Normothermic Machine Perfusion of Donor Livers

Ex Situ Normotérmica máquina de perfusão de fígados doados

In contrast to conventional static cold preservation (0-4 &#176;C), ex situ machine perfusion may provide better preservation of donor livers. Continuous ...

Normothermic Ex Vivo Kidney Perfusion for the Preservation of Kidney Grafts prior to Transplantation

Normothermic Ex Vivo Kidney Perfusion for the Preservation of Kidney Grafts prior to Transplantation

Normotérmica<em&gt; Ex Vivo</em&gt; Perfusão rim para a Preservação do rim Os enxertos antes do transplante

Kidney transplantation has become a well-established treatment option for patients with end-stage renal failure. The persisting organ shortage remains a ...

Assessment of Plasma Coagulation on Liver Tissue in a Large Animal Model In Vivo

Assessment of Plasma Coagulation on Liver Tissue in a Large Animal Model In Vivo

Avaliação da coagulação do Plasma no tecido do fígado em um modelo Animal grande na Vivo

Plasma coagulation as a form of electrocautery is used in liver surgery for decades to seal the large liver cut surface after major hepatectomy to prevent ...

A Small Animal Model of Ex Vivo Normothermic Liver Perfusion

A Small Animal Model of Ex Vivo Normothermic Liver Perfusion

Um pequeno modelo Animal de perfusão de fígado normotérmica Ex Vivo

There is a significant shortage of liver allografts available for transplantation, and in response the donor criteria have been expanded. As a result, ...

Normothermic Ex Situ Heart Perfusion in Working Mode: Assessment of Cardiac Function and Metabolism

Normotérmica Ex Situ coração perfusão na modalidade de trabalho: avaliação da função cardíaca e metabolismo

The current standard method for organ preservation (cold storage, CS), exposes the heart to a period of cold ischemia that limits the safe preservation ...

Pre-clinical Model of Cardiac Donation after Circulatory Death

Modelo pré-clínico de doação cardíaca após a morte circulatória

Cardiac transplantation demand is on the rise; nevertheless, organ availability is limited due to a paucity of suitable donors. Organ donation after ...

A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion

Um grande modelo animal para lesão renal aguda por oclusão bilateral temporária da artéria renal

Acute kidney injury (AKI) is associated with higher risk for morbidity and mortality post-operatively. Ischemia-reperfusion injury (IRI) is the most ...

Large Animal Model for Evaluating the Efficacy of the Gene Therapy in Ischemic Heart

Coronary artery disease is one of the significant causes of mortality and morbidity worldwide. Despite the progression of current therapeutics, a ...

Normothermic Negative Pressure Ventilation Ex Situ Lung Perfusion: Evaluation of Lung Function and Metabolism

Normothermic Negative Pressure Ventilation Ex Situ Lung Perfusion: Evaluation of Lung Function and Metabolism

Perfusão pulmonar ex situ com pressão negativa normotérmica: avaliação da função e metabolismo pulmonar

Lung transplantation (LTx) remains the standard of care for end-stage lung disease. A shortage of suitable donor organs and concerns over donor organ ...