Division of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Division of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children; Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, China.
J Heart Lung Transplant. 2020 Mar;39(3):267-277. doi: 10.1016/j.healun.2019.11.023. Epub 2019 Dec 5.
The optimal blood flow and pressure to perfuse pediatric hearts from donation after circulatory death (DCD) on the ex vivo perfusion system has not been elucidated. This study sought to investigate the optimal perfusion strategy for pediatric DCD hearts by using a juvenile porcine model comparing pressure- vs flow-targeted strategy.
The hearts of the juvenile DCD pigs were explanted, and the coronary arteries were perfused for 2 hours by the ex vivo heart perfusion system with 2 different perfusion strategies; pressure-targeted perfusion (target coronary perfusion pressure: 40 mm Hg, group A) and flow-targeted perfusion (target coronary perfusion flow: 10 ml/kg/min, group B). The working model heart perfusion was used to assess systolic and diastolic myocardial performance.
The body weight, warm and cold ischemic time, and ex vivo perfusion time were comparable between the groups. In the working model, group B showed significantly preserved cardiac output (A: 70.5 ± 15.3 ml/kg/min vs B: 113.8 ± 15.0 ml/kg/min, p < 0.01), stroke volume (A: 0.4 ± 0.1 ml/kg vs B: 0.7 ± 0.1 ml/kg, p < 0.01), and ejection fraction (A: 18.8% ± 5.9% vs B: 35.0% ± 10.6%, p < 0.01). E/e' and Tei index were also significantly preserved in group B. The percentage gain of heart weight after ex vivo (net increase of the heart weight divided by heart weight at baseline) was significantly smaller in group B (A: 20.0% ± 5.3% vs B: 11.6% ± 5.0%, p < 0.05). Troponin-I, myocardial hemorrhage, oxidative stress markers; myeloperoxidase and 8-hydroxy-2'-deoxyguanosine were also significantly lower after ex vivo perfusion in group B (p < 0.05).
The tightly controlled flow-targeted myocardial perfusion strategy for DCD donor hearts achieved better myocardial performance by causing less myocardial edema and limiting myocardial reperfusion injury.
在体外灌注系统中，用于从脑死亡后捐献（DCD）的儿科供心的最佳血流和压力尚未阐明。本研究旨在通过使用幼年猪模型比较压力目标与流量目标策略，来研究儿科 DCD 供心的最佳灌注策略。
将幼年 DCD 猪的心离体，用体外心脏灌注系统用两种不同的灌注策略（目标冠状动脉灌注压：40mmHg，A 组；目标冠状动脉灌注流量：10ml/kg/min，B 组）灌注 2 小时。采用工作模型心脏灌注评估心肌收缩和舒张功能。
两组间体重、热缺血和冷缺血时间以及体外灌注时间相似。在工作模型中，B 组心输出量（A：70.5±15.3ml/kg/min 比 B：113.8±15.0ml/kg/min，p<0.01）、每搏量（A：0.4±0.1ml/kg 比 B：0.7±0.1ml/kg，p<0.01）和射血分数（A：18.8%±5.9%比 B：35.0%±10.6%，p<0.01）明显更好。B 组的 E/e'和 Tei 指数也明显更高。体外后心脏重量的百分比增加（体外后心脏重量的净增加除以基线时的心脏重量）在 B 组明显更小（A：20.0%±5.3%比 B：11.6%±5.0%，p<0.05）。B 组的肌钙蛋白 I、心肌出血、氧化应激标志物；髓过氧化物酶和 8-羟基-2'-脱氧鸟苷也明显更低。
DCD 供心的严格控制流量目标心肌灌注策略通过减少心肌水肿和限制心肌再灌注损伤，实现了更好的心肌功能。
