Myocardial Microcirculation Combined With Lactate Measurements Predicts Ventricular Contractility in a Canine DCD Orthotopic Heart Transplantation During Ex Situ Machine Perfusion

Saemann, Lars and Ferencz, Robert and Benke, Kálmán and Veres, Gábor and Willsch, Jan and Große, Marco and Spornhauer, Andreas and Stiller, Markus and Bálint, Tímea and Damenija, Givi and Barta, Bálint András and Spiesshofer, Sylvia and Stengl, Roland and Csonka, Máté and Simm, Andreas and Radovits, Tamás and Szabó, Gábor (2026) Myocardial Microcirculation Combined With Lactate Measurements Predicts Ventricular Contractility in a Canine DCD Orthotopic Heart Transplantation During Ex Situ Machine Perfusion. TRANSPLANTATION, 110 (5). pp. 999-1003. ISSN 0041-1337

Text myocardial-microcirculation-combined-with-lactate.pdf - Published Version Restricted to Registered users only Download (1MB)

Abstract

Background. Strictly trusting lactate to classify a donation after circulatory death (DCD) heart as transplantable or not during ex vivo blood perfusion (EVBP) has been criticized. Here, we verified novel prediction parameters based on myocardial microcirculation, which we had developed in previous porcine Langendorff experiments, in canine orthotopic heart transplantation (HTx) with DCD. Methods. The hearts (n = 7) were maintained by EVBP. We measured lactate, monitored the myocardial microcirculation in the left-ventricular (LV) anterior wall during EVBP, using a laser Doppler perfusion (LDP) needle probe, and developed a prediction model based on LDP shifts and venous lactate during EVBP. The hearts were transplanted, and the LV-end-systolic pressure volume relationship (ESPVR) was determined. Considering that reaching at least 80% of the donor-LV-ESPVR is acceptable to maintain circulation in the recipient, we also calculated sensitivity and Specificity of the model to predict that 80% of the donor-LV-ESPVR will be reached after HTx. Results. The combination of the LDP shift and venous lactate in a linear model showed the highest r (0.950) and r2 (0.902) for LV-ESPVR and thus served best for a prediction model. The respective, exemplary formula to predict that at least 80% of the donor-LV-ESPVR will be reached after HTx showed a sensitivity of 100% and a specificity of 83.3%. Conclusions. We conclude that the LV-ESPVR after orthotopic HTx with DCD seems to be predictable by combining the microcirculatory parameter First-to-Lastinterval shift during, and the Lacven at the end of EVBP in a linear model.

Actions (login required)

View Item