Clamping of the Aortic Arch Vessels During Normothermic Regional Perfusion Does Not Negatively Affect Donor Cardiac Function in Donation After Circulatory Death

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Clamping of the Aortic Arch Vessels During Normothermic Regional Perfusion Does Not Negatively Affect Donor Cardiac Function in Donation After Circulatory Death. / Moeslund, Niels; Zhang, Zhang Long; Dalsgaard, Frederik Flyvholm et al.

I: Transplantation, Bind 107, Nr. 1, 01.2023.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

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@article{cd111d79b97c45d9abb2ac553bb3b204,
title = "Clamping of the Aortic Arch Vessels During Normothermic Regional Perfusion Does Not Negatively Affect Donor Cardiac Function in Donation After Circulatory Death",
abstract = "BACKGROUND: The hemodynamic effects of aortic arch vessel (AAV) clamping during normothermic regional perfusion (NRP) in donation after circulatory death is unknown. We investigated effects of AAV clamping during NRP compared with no clamping in a porcine model.METHODS: In 16 pigs, hemodynamic parameters were recorded including biventricular pressure-volume measurements and invasive blood pressure. Additionally, blood gas parameters and inflammatory cytokines were used to assess the effect of AAV clamping. The animals were centrally cannulated for NRP, and baseline measurements were obtained before hypoxic circulatory arrest was induced by halting mechanical ventilation. During an 8-min asystole period, the animals were randomized to clamp (n = 8) or no-clamp (n = 8) of the AAV before commencement of NRP. During NRP, circulation was supported with norepinephrine (NE) and dobutamine. After 30 min of NRP, animals were weaned and observed for 180 min post-NRP.RESULTS: All hearts were successfully reanimated and weaned from NRP. The nonclamp groups received significantly more NE to maintain a mean arterial pressure >60 mm Hg during and after NRP compared with the clamp group. There were no between group differences in blood pressure or cardiac output. Pressure-volume measurements demonstrated preserved cardiac function' including ejection fraction and diastolic and systolic function. No between group differences in inflammatory markers were observed.CONCLUSION: AAV clamping did not negatively affect donor cardiac function or inflammation after circulatory death and NRP. Significantly less NE was used to support in the clamp group than in the nonclamp group.",
keywords = "Animals, Aorta, Thoracic, Death, Heart Arrest, Humans, Organ Preservation, Perfusion/adverse effects, Swine, Tissue Donors, Tissue and Organ Harvesting",
author = "Niels Moeslund and Zhang, {Zhang Long} and Dalsgaard, {Frederik Flyvholm} and Glenting, {Sif Bay} and Ilkjaer, {Lars Bo} and Pia Ryhammer and Johan Palmfeldt and Michael Pedersen and Michiel Erasmus and Hans Eiskjaer",
year = "2023",
month = jan,
doi = "10.1097/TP.0000000000004298",
language = "English",
volume = "107",
journal = "Transplantation",
issn = "0041-1337",
publisher = "LIPPINCOTT WILLIAMS & WILKINS",
number = "1",

}

RIS

TY - JOUR

T1 - Clamping of the Aortic Arch Vessels During Normothermic Regional Perfusion Does Not Negatively Affect Donor Cardiac Function in Donation After Circulatory Death

AU - Moeslund, Niels

AU - Zhang, Zhang Long

AU - Dalsgaard, Frederik Flyvholm

AU - Glenting, Sif Bay

AU - Ilkjaer, Lars Bo

AU - Ryhammer, Pia

AU - Palmfeldt, Johan

AU - Pedersen, Michael

AU - Erasmus, Michiel

AU - Eiskjaer, Hans

PY - 2023/1

Y1 - 2023/1

N2 - BACKGROUND: The hemodynamic effects of aortic arch vessel (AAV) clamping during normothermic regional perfusion (NRP) in donation after circulatory death is unknown. We investigated effects of AAV clamping during NRP compared with no clamping in a porcine model.METHODS: In 16 pigs, hemodynamic parameters were recorded including biventricular pressure-volume measurements and invasive blood pressure. Additionally, blood gas parameters and inflammatory cytokines were used to assess the effect of AAV clamping. The animals were centrally cannulated for NRP, and baseline measurements were obtained before hypoxic circulatory arrest was induced by halting mechanical ventilation. During an 8-min asystole period, the animals were randomized to clamp (n = 8) or no-clamp (n = 8) of the AAV before commencement of NRP. During NRP, circulation was supported with norepinephrine (NE) and dobutamine. After 30 min of NRP, animals were weaned and observed for 180 min post-NRP.RESULTS: All hearts were successfully reanimated and weaned from NRP. The nonclamp groups received significantly more NE to maintain a mean arterial pressure >60 mm Hg during and after NRP compared with the clamp group. There were no between group differences in blood pressure or cardiac output. Pressure-volume measurements demonstrated preserved cardiac function' including ejection fraction and diastolic and systolic function. No between group differences in inflammatory markers were observed.CONCLUSION: AAV clamping did not negatively affect donor cardiac function or inflammation after circulatory death and NRP. Significantly less NE was used to support in the clamp group than in the nonclamp group.

AB - BACKGROUND: The hemodynamic effects of aortic arch vessel (AAV) clamping during normothermic regional perfusion (NRP) in donation after circulatory death is unknown. We investigated effects of AAV clamping during NRP compared with no clamping in a porcine model.METHODS: In 16 pigs, hemodynamic parameters were recorded including biventricular pressure-volume measurements and invasive blood pressure. Additionally, blood gas parameters and inflammatory cytokines were used to assess the effect of AAV clamping. The animals were centrally cannulated for NRP, and baseline measurements were obtained before hypoxic circulatory arrest was induced by halting mechanical ventilation. During an 8-min asystole period, the animals were randomized to clamp (n = 8) or no-clamp (n = 8) of the AAV before commencement of NRP. During NRP, circulation was supported with norepinephrine (NE) and dobutamine. After 30 min of NRP, animals were weaned and observed for 180 min post-NRP.RESULTS: All hearts were successfully reanimated and weaned from NRP. The nonclamp groups received significantly more NE to maintain a mean arterial pressure >60 mm Hg during and after NRP compared with the clamp group. There were no between group differences in blood pressure or cardiac output. Pressure-volume measurements demonstrated preserved cardiac function' including ejection fraction and diastolic and systolic function. No between group differences in inflammatory markers were observed.CONCLUSION: AAV clamping did not negatively affect donor cardiac function or inflammation after circulatory death and NRP. Significantly less NE was used to support in the clamp group than in the nonclamp group.

KW - Animals

KW - Aorta, Thoracic

KW - Death

KW - Heart Arrest

KW - Humans

KW - Organ Preservation

KW - Perfusion/adverse effects

KW - Swine

KW - Tissue Donors

KW - Tissue and Organ Harvesting

U2 - 10.1097/TP.0000000000004298

DO - 10.1097/TP.0000000000004298

M3 - Journal article

C2 - 36042552

VL - 107

JO - Transplantation

JF - Transplantation

SN - 0041-1337

IS - 1

ER -