Dynamics of the morphofunctional status of the isolated cardiopulmonary complex under conditions of normothermic autoperfusion ex vivo

• Smirnov Yа.M.
• Zhulkov M.O.
• Zykov I.S.
• Sirota D.A.
• Tarkova A.R.
• Kliver E.E.
• Kliver V.E.
• Volkov A.M.
• Agaeva Kh.A.
• Karmadonova N.A.
• Surovtseva M.A.
• Kim I.I.
• Poveshchenko O.V.
• Kosimov F.Yu.
• Murtazaliev M.N.
• Guseva A.V.

Abstract

Background. The limited period of safe pharmaco-cold preservation of the donor heart significantly limits the possibilities of remote transplant collection, which leads to organ failure and high mortality of patients on the waiting list. Normothermic autoperfusion as part of the ex vivo cardiopulmonary complex is an alternative method of the heart preservation.

Aim – to evaluate the morphofunctional status of the autoperfused cardiopulmonary complex
in the experiment.

Material and methods. Landrace pigs weighing 50±5 kg and aged 4–5 months (n=10) were used as models for the series of sequential experiments. After hemodynamic isolation, the autoperfused cardiopulmonary complex was explanted and placed in a thermostatic (37 °C) box. During a 6-hour observation, the heart was monitored by measuring hemodynamic parameters, myocardial contractility and blood gases flowing from the coronary sinus.

Results. During the 6-hours conditioning of the cardiopulmonary complex under conditions of normothermic autoperfusion, the hemodynamics and contractile function of the heart were stable. Despite the reduction in flow and pressure in the pulmonary circulation, the parameters of the blood gas composition remain within the reference range. During the experiment, a decreased leukocytes count in the level of leukocytes in the perfusate and moderate leukocyte infiltration of the pulmonary parenchyma were observed.

Conclusion. Despite the fact that normothermic autoperfusion effectively preserves the pumping function of the heart ex vivo for 6 hours, optimal perfusate composition and the choice of perfusion regimen require further research.

Keywords: autoperfusion; heart preservation; normothermic perfusion; reperfusion injury; heart transplantation; pharmaco-cold preservation

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