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J Thorac Cardiovasc Surg 2003;125:1217-1228
© 2003 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Myocardial viability twenty-four hours after orthotopic heart transplantation from non-heart-beating donors

From the Department of Cardiovascular Surgery^a and the Institute of Pathological Anatomy,^b Albert-Ludwigs-University Medical Center, Freiburg, Germany.

Supported by the Clinical Research Center II of the Albert-Ludwigs-University Freiburg, grant No B4. HOE 642 was a gift of Hoechst AG, Frankfurt/Main, Germany. Leukocyte filters were a gift of Pall GmbH, Dreieich, Germany.

Received for publication May 29, 2002. Revisions requested July 30, 2002; revisions received Aug 7, 2002. Accepted for publication Aug 15, 2002. Address for reprints: Juergen Martin, MD, Department of Cardiovascular Surgery, Albert-Ludwigs-University, Hugstetter Str 55, D-79106 Freiburg, Germany (E-mail: Martin{at}ch11.ukl.uni-freiburg.de).

Objectives: Using a new preservation strategy, we investigated the performance of hearts from non-heart-beating donors during an observation period of 24 hours after orthotopic heart transplantation in a pig model.
Methods: In the control group (n = 6) beating donor hearts were harvested with Bretschneider's HTK solution and transplanted orthotopically without reperfusion modifications. In the non-heart-beating donor group (n = 6) hearts were perfused with leukocyte-depleted blood cardioplegia after 30 minutes of normothermic ischemia. Blood cardioplegia was supplemented with a sodium-hydrogen exchange inhibitor and adenosine. After transplantation, a second controlled reperfusion with blood cardioplegia was performed.
Results: Preload recruitable stroke work of the left ventricle 24 hours after transplantation in the control versus non-heart-beating donor group was 108% ± 24% versus 103% ± 18% of baseline values. Myocardial blood flow of the left and right ventricle was increased to 146% ± 32% and 176% ± 51% in the control group versus 176% ± 29% and 194% ± 27% in the non-heart-beating donor group. Myocardial oxygen consumption was 11.2 ± 2.1 versus 12.8 ± 2.2 mL/100 g per minute at baseline and 11.6 ± 2.6 versus 13.2 ± 3.1 mL/100 g per minute after 24 hours (not significant). Histologic examination with Luxol fast blue staining revealed that 2.6% ± 4.8% of myocytes in the control group versus 1.8% ± 1.9% in the non-heart-beating donor group were damaged irreversibly.
Conclusions: Recovery of donor hearts from non-heart-beating donors is comparable with recovery of organs harvested from heart-beating donors if the above-mentioned preservation technique is used. These results could encourage the use of marginal donor hearts and help to expand the limited donor pool.