Title : Maintaining cardiac output in swine post-heart transplantation: Efficacy of an anesthetic protocol
Abstract:
The National Cardiac Surgery Research Center has innovated an ex vivo perfusion machine, facilitating reperfusion of a harvested heart with warm, oxygenated, nutrient-enriched donor blood within a 24-hour timeframe. Limited data exists on cardiac performance and tissue oxygenation of pig allografts following extended ex vivo machine perfusion. Optimal perioperative conditions significantly impact pig survival and experimental outcomes. Thus, this study seeks to refine an anesthetic protocol tailored to the specific requirements of pig heart transplantation and evaluate hemodynamic parameters using the pulmonary arterial thermodilution technique before and after transplantation.
Methods:
Ten orthotopic allogeneic heart transplants were performed in Yorkshire pigs, whereby the harvested hearts were maintained between donor and recipient on the innovative ex-vivo machine over a 24 hour period. Changes in haemodynamic parameters and tissue oxygenation between the donor and recipient pigs were assessed using Swan Ganz and arterial lines.
Results:
Cardiac output (CO) of the graft after weaning from CPB was significantly higher than the initial CO of the donor pig. This trend continued 2 hours after sternal closure. The post-transplant heart rate and systemic vascular resistance were substantially increased. Hemoglobin levels decreased due to hemodilution and surgical bleeding, which contributed to both decreased oxygen delivery and increased lactate levels.
Conclusion:
The donor pig heart exceeded baseline cardiac output after 24 hours of ex vivo perfusion in the early postoperative phase. Nevertheless, achieving this required the administration of inotropic agents and vasopressors. The anesthetic protocol may serve as a valuable resource for researchers involved in similar studies.
What will audience learn from your presentation?
Our research introduces a novel approach by leveraging ex vivo perfusion technology for swine heart transplantation. The innovation lies in optimizing cardiac output through a tailored anesthetic protocol. This protocol, combined with the extended machine perfusion timeframe, demonstrates the potential to enhance post-transplantation outcomes. Our findings open avenues for further advancements in cardiac transplantation research.
