Evaluation of the coronary status of an autoperfused donor heart in the experiment

• Zhulkov M.O.
• Zaynobudinov Sh.Sh.
• Sirota D.A.
• Andrey V. Protopopov
• Zykov I.S.
• Makaev A.G.
• Karmadonova N.A.
• Murtazaliev M.N.
• Kosimov F.Yu.
• Tarkova A.R.
• Agaeva Kh.A.
• Frykina O.E.
• Kobelev E.

Abstract

Aim – to develop a protocol and assess the coronary status of an autoperfused heart ex vivo in an experiment.

Material and methods. Landrace pigs were used as an experimental model for a series of acute experiments (n=10). The explantation of a working cardiopulmonary complex was performed according to the method described in the literature. After placing the complex ex vivo, selective catheterization of the right and left coronary arteries was performed using catheters of the Judkins 4Fr modification (Judkins Right&Left, Perfoma, Merit medical, USA) in standard projections. During the experiment, invasive pressure in the cavities of the heart and main arteries, blood gas composition, and myocardial contractility were monitored.

Results. In the course of a series of experiments, a protocol for selective catheterization of the coronary arteries was developed. The resulting films made it possible to conduct a qualitative assessment of the coronary status due to the natural antegrade coronary blood flow and as close as possible to the real syntopy. None of the experiments recorded episodes of a decrease in myocardial contractility or the occurrence of arrhythmias in response to intracoronary administration of a radiopaque substance.

Conclusion. The developed protocol for selective coronary angiography of an autoperfused heart ex vivo provides high-quality visualization of the coronary bed of a donor heart, without a negative effect on myocardial contractility and survival time of an isolated cardiopulmonary drug in the experiment.

Keywords:chronic heart failure; heart transplantation; heart preservation; autoperfusion; donor organ preservation; ex vivo organ perfusion

References

1.     Hauptman P.J., O’Connor K.J., Wolf R.E., McNeil B.J. Angiography of potential cardiac donors. J Am Coll Cardiol. 2001; 37 (5): 1252–8. DOI: https://doi.org/10.1016/s0735-1097(01)01134-2  

2.     Pinto C.S., Prieto D., Antunes M.J. Coronary artery bypass graft surgery during heart transplantation. Interact Cardiovasc Thorac Surg. 2013; 16 (2): 224–5. DOI: https://doi.org/10.1093/icvts/ivs432  

3.     Kotloff R.M., Blosser S., Fulda G.J., Malinoski D., Ahya V.N., Angel L., et al.; Society of Critical Care Medicine/American College of Chest Physicians/Association of Organ Procurement Organizations Donor Management Task Force. Management of the Potential Organ Donor in the ICU: Society of Critical Care Medicine/American College of Chest Physicians/Association of Organ Procurement Organizations Consensus Statement. Crit Care Med. 2015; 43 (6): 1291–325. DOI: https://doi.org/10.1097/CCM.0000000000000958  

4.     Choi H.Y., Cho K.H., Jin C., Lee J., Kim T.H., Jung W.S., et al. Exercise therapies for Parkinson’s disease: a systematic review and meta-analysis. Parkinsons Dis. 2020; 2020: 2565320. DOI: https://doi.org/10.1155/2020/2565320  

5.     Pinnelas R., Kobashigawa J.A. Ex vivo normothermic perfusion in heart transplantation: a review of the TransMedics^® Organ Care System. Future Cardiol. 2022; 18 (1): 5–15. DOI: https://doi.org/10.2217/fca-2021-0030  

6.     Zhul’kov M.O., Zykov I.S., Sirota D.A., Agaeva H.A., Sabetov A.K., Poveshchenko O.V., et al. Long-term conditioning of a donor heart by autoperfusion. Vestnik experimental’noy i klinicheskoy khirurgii [Bulletin of Experimental and Clinical Surgery]. 2022; 15 (3): 214–20. (in Russian)

7.     Zhul’kov M.O., Sirota D.A., Zykov I.S., Sabetov A.K., Agaeva H.A., Makaev A.G., et al. Safety of intracoronary iopromide solution for experimental pharmaco-cold ex vivo preservation of donor heart. Patologiya krovoobrashcheniya i kardiokhirurgiya [Pathology of Blood Circulation and Cardiac Surgery]. 2022; 26 (4): 42–51. DOI: https://doi.org/10.21688/1681-3472-2022-4-42-51  (in Russian)

8.     Carvalho W.D.N., Gonçalves K.C., Miranda A.L., Maria G.D.S.A., de Fátima Silqueira S.M., Moreira M.D.C.V. Profile of effective donors for heart transplantation: experience of a Brazilian Center. Transplant Proc. 2019; 51 (6): 1684–8. DOI: https://doi.org/10.1016/j.transproceed.2019.05.011  

9.     Dolan R.S., Rahsepar A.A., Blaisdell J., Sarnari R., Ghafourian K., Wilcox J.E., et al. Donor and recipient characteristics in heart transplantation are associated with altered myocardial tissue structure and cardiac function. Radiol Cardiothorac Imaging. 2019; 1 (5): e190009. DOI: https://doi.org/10.1148/ryct.2019190009  

10. Towbin J.A., McKenna W.J., Abrams D.J., Ackerman M.J., Calkins H., Darrieux F.C.C., et al. 2019 HRS expert consensus statement on evaluation, risk stratification, and management of arrhythmogenic cardiomyopathy. Heart Rhythm. 2019; 16 (11): e301–72. DOI: https://doi.org/10.1016/j.hrthm.2019.05.007    

11. Doctorian T., Narasimha D., Stoletniy L., Sakr A. 91-year-old allograft: oldest surviving donor heart still going: a case report. Transplant Proc. 2017; 49 (7): 1663–6. DOI: https://doi.org/10.1016/j.transproceed.2017.06.006  

12. Kilic A., Emani S., Sai-Sudhakar C.B., Higgins R.S., Whitson B.A. Donor selection in heart transplantation. J Thorac Dis. 2014; 6 (8): 1097–104. DOI: https://doi.org/10.3978/j.issn.2072-1439.2014.03.23  

13. Guglin M., Omar H.R., Wright C. Underutilization of donor hearts: an observational study. Transplant Proc. 2018; 50 (10): 3698–704. DOI: https://doi.org/10.1016/j.transproceed.2018.06.019  

14. Vieira J.L., Mehra M.R. Heart transplantation candidacy. Curr Opin Organ Transplant. 2021; 26 (1): 69–76. DOI: https://doi.org/10.1097/MOT.0000000000000828  

15. Grauhan O., Siniawski H., Dandel M., Lehmkuhl H., Knosalla C., Pasic M., et al. Coronary atherosclerosis of the donor heart – impact on early graft failure. Eur J Cardiothorac Surg. 2007; 32 (4): 634–8. DOI: https://doi.org/10.1016/j.ejcts.2007.07.007  

16. Musci M., Pasic M., Grauhan O., Butter C., Potapov E., Weng Y., et al. Orthotopic heart transplantation with concurrent coronary artery bypass grafting or previous stent implantation. Z Kardiol. 2004; 93 (12): 971–4. DOI: https://doi.org/10.1007/s00392-004-0158-1  

17. Ivanes F., Cantrelle C., Genet T., Le Feuvre C., Legeai C., Jasseron C., et al. Performing diagnostic coronary angiography to evaluate high-risk cardiac donors: a French nationwide cohort study. Int J Cardiol. 2019; 277: 71–8. DOI: https://doi.org/10.1016/j.ijcard.2018.08.003  

18. Khamis R.Y., Ammari T., Mikhail G.W. Gender differences in coronary heart disease //Heart. 2016. Vol. 102, N 14. P. 1142-1149.  DOI: 10.1136/heartjnl-2014-306463

19. Dorent R., Gandjbakhch E., Goéminne C., Ivanes F., Sebbag L., Bauer F., et al. Assessment of potential heart donors: a statement from the French heart transplant community. Arch Cardiovasc Dis. 2018; 111 (2): 126–39. DOI: https://doi.org/10.1016/j.acvd.2017.12.001  

20. Dahiya G., McQuade D., Alpert C. Myocardial bridging in the era of a drug epidemic: a case report addressing the need to revisit donor organ assessment. Eur Heart J Case Rep. 2019; 3 (4): 1–4. DOI: https://doi.org/10.1093/ehjcr/ytz203  

21. Zuckermann A., Auersperg K., Kaider A., Sutlic Z., Gummert J., Berchtold-Herz M., et al. Сoronary angiography of potential cardiac donors increases cardiac transplantation rates. J Heart Lung Transplant. 2018; 37 (4): 171.

22. Yang H.S., Chen I.C., Lee Y.T., Lee K.C., Chuang Y.C., Chang C.Y., et al. Cardiac transplantation and concomitant coronary artery bypass grafting: our experiences in 11 cases. Transplant Proc. 2014; 46 (3): 900–2. DOI: https://doi.org/10.1016/j.transproceed.2013.11.127  

23. Zeraatian Nejad S., Akhlaghpasand M., Mohammadi I., Soltani K., Eghbali F. First successful human coronary artery bypass surgery postoperative heart transplant: a case report. Exp Clin Transplant. 2022; 20 (12): 1141–4. DOI: https://doi.org/10.6002/ect.2022.0312  

24. Rao J.N., Prendergast B., Dark J.H. Orthotopic heart transplantation with concurrent aortic valve replacement and coronary artery bypass grafting //The Journal of heart and lung transplantation. 2000. Vol. 19, N 9. P. 897-899. DOI: 10.1016/s1053-2498(00)00158-3

25. Marelli D., Laks H., Bresson S., Ardehali A., Bresson J., Esmailian F., et al. Results after transplantation using donor hearts with preexisting coronary artery disease. J Thorac Cardiovasc Surg. 2003; 126 (3): 821–5. DOI: https://doi.org/10.1016/s0022-5223(03)00213-7   

26. Anthony C., Michel J., Christofi M., Wilson S.H., Granger E., Cropper J., et al. Ex vivo coronary angiographic evaluation of a beating donor heart. Circulation. 2014; 130 (25): e341–3. DOI: https://doi.org/10.1161/CIRCULATIONAHA.114.010289  

27. Meredith T., Scheuer S., Hoffman M., Joshi Y., Kathir K., Gunalingam B., et al. Coronary angiography of the ex-situ beating donor heart in a portable organ care system. Catheter Cardiovasc Interv. 2022; 100 (7): 1252–60. DOI: https://doi.org/10.1002/ccd.30455   

28. Ghodsizad A., Bordel V., Ungerer M., Karck M., Bekeredjian R., Ruhparwar A. Ex vivo coronary angiography of a donor heart in the organ care system. Heart Surg Forum. 2012; 15 (3): E161–3. DOI: https://doi.org/10.1532/HSF98.20111146