Ghodsizad Ali, Bordel Viktor, Ungerer Matthias, Karck Matthias, Bekeredjian Raffi, Ruhparwar Arjang
Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany.
Heart Surg Forum. 2012 Jun;15(3):E161-3. doi: 10.1532/HSF98.20111146.
The international demand for donor hearts for transplantation is steadily increasing. Thus, longer transportation distances and explantation from sites with limited abilities for preexplantation diagnostics have to be considered. The development of the Organ Care System® (OCS) (TransMedics, Andover, MA, USA) may extend the extracorporeal period, with the possibility to constantly evaluate and interact during organ transport. One of the potential advantages of the OCS® is the ability to even perform coronary angiography of the donor heart, if a preexplantation angiography evaluation is not possible at the donor hospital and if significant evidence for coronary artery disease in the donor heart becomes known, because of the donor's medical history or after palpation of sclerotic coronary ostia. In this report, we present the first ex vivo coronary angiography evaluation of a potential donor heart that was performed in the OCS®. Upon explantation of the donor heart, sclerosis of the left coronary artery was palpated. After reaching the implantation site, a coronary angiography was performed by placing the OCS® on a catheterization table and inserting a 6F sheath into the access site of the OCS®. A 6F guide catheter was used to intubate the left coronary ostium. Injection of contrast agent led to strong contrast for visualization of the left coronary system. This procedure allowed sufficient assessment of the coronary arteries, which showed a slight diffuse sclerosis without any significant stenosis. This report demonstrates the advantage of the OCS® in the complex assessment of donor hearts after explantation. While the donor heart is still in the OCS®, not only is it possible to measure metabolic parameters and pressures, but even coronary angiography is feasible. With the increasing international demand for donor organs, such ex vivo examinations might play a more important role, because longer transportation distances can be accepted and organs from suboptimal donors without preexplantation diagnostics may be considered at donor sites with limited diagnostic options.
国际上对用于移植的供体心脏的需求正在稳步增长。因此，必须考虑更长的运输距离以及从术前诊断能力有限的地点获取心脏。器官护理系统（OCS）（美国马萨诸塞州安多弗市的TransMedics公司）的发展可能会延长体外保存时间，并有可能在器官运输过程中持续进行评估和干预。OCS的潜在优势之一是，如果供体医院无法进行术前血管造影评估，且由于供体病史或触诊发现冠状动脉开口硬化而得知供体心脏存在冠状动脉疾病的重要证据，那么甚至可以对供体心脏进行冠状动脉造影。在本报告中，我们展示了在OCS中对潜在供体心脏进行的首次体外冠状动脉造影评估。在取出供体心脏时，触诊发现左冠状动脉硬化。到达植入地点后，将OCS放置在导管检查台上，并将一个6F鞘管插入OCS的接入部位，然后进行冠状动脉造影。使用一个6F引导导管插入左冠状动脉开口。注射造影剂后，左冠状动脉系统清晰显影。该操作能够充分评估冠状动脉，结果显示有轻微的弥漫性硬化，但无明显狭窄。本报告证明了OCS在取出后对供体心脏进行复杂评估方面的优势。当供体心脏仍在OCS中时，不仅可以测量代谢参数和压力，甚至进行冠状动脉造影也是可行的。随着国际上对供体器官需求的增加，这种体外检查可能会发挥更重要的作用，因为可以接受更长的运输距离，并且在诊断选择有限的供体地点，可以考虑使用未进行术前诊断的次优供体的器官。
