通过心肌微循环与替代参数监测体外机器灌注期间的灌注质量和预测供心功能
Monitoring of perfusion quality and prediction of donor heart function during ex-vivo machine perfusion by myocardial microcirculation versus surrogate parameters.
作者信息
Saemann Lars, Wenzel Folker, Kohl Matthias, Korkmaz-Icöz Sevil, Hoorn Fabio, Loganathan Sivakkanan, Guo Yuxing, Ding Qingwei, Zhou Pengyu, Veres Gábor, Karck Matthias, Szabó Gábor
机构信息
Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany; Department of Cardiac Surgery, University of Halle, Halle, Germany; Faculty Medical and Life Sciences, Furtwangen University, Villingen-Schwenningen, Germany.
Faculty Medical and Life Sciences, Furtwangen University, Villingen-Schwenningen, Germany.
出版信息
J Heart Lung Transplant. 2021 May;40(5):387-391. doi: 10.1016/j.healun.2021.02.013. Epub 2021 Feb 22.
Currently, lactate (Lac) is used to evaluate machine perfusion (MP) of hearts, donated after circulatory death (DCD). We hypothesize that monitoring of myocardial microcirculation (mLDP) by Laser-Doppler-Perfusion is superior to Lac to evaluate perfusion and predict contractility. In a pig model, DCD-hearts were perfused 4 hours followed by reperfusion and left ventricular contractility measurement. Lac and mLDP were measured every 30 min in successfully (N = 9) and unsuccessfully (N = 7) maintained hearts. Successfully maintained hearts showed decreasing Lac (5.6 to 2.8 mmol/L) and slightly downregulated (92%) mLDP. In unsuccessfully maintained hearts Lac first decreased (5.1 to 3.8 mmol/L) followed by increase and mLDP dropped to 39%. In a single-variable regression only mLDP showed a significant r² for systolic (0.514, p = 0.045) and diastolic (0.501, p = 0.049) parameters. The combination of mLDP and Lac (r = 0.876, p = 0.005) showed best results. mLDP seems to be superior to Lac to show perfusion disorders and predict DCD-heart contractility.
目前，乳酸（Lac）被用于评估心脏死亡后捐赠的心脏的机器灌注（MP）。我们假设，通过激光多普勒灌注监测心肌微循环（mLDP）在评估灌注和预测收缩性方面优于Lac。在猪模型中，对心脏死亡后捐赠的心脏进行4小时灌注，随后进行再灌注并测量左心室收缩性。在成功维持灌注的心脏（N = 9）和未成功维持灌注的心脏（N = 7）中，每30分钟测量一次Lac和mLDP。成功维持灌注的心脏显示Lac降低（从5.6降至2.8 mmol/L），mLDP略有下调（92%）。在未成功维持灌注的心脏中，Lac首先降低（从5.1降至3.8 mmol/L），随后升高，mLDP降至39%。在单变量回归中，只有mLDP在收缩期（r² = 0.514，p = 0.045）和舒张期（r² = 0.501，p = 0.049）参数方面显示出显著的r²。mLDP和Lac的组合（r = 0.876，p = 0.005）显示出最佳结果。mLDP在显示灌注障碍和预测心脏死亡后捐赠的心脏的收缩性方面似乎优于Lac。
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