loading page

Echocardiographic Assessment of Left Ventricular Function in Ex Situ Heart Perfusion using Pump Supported and Passive Afterload Working Mode, a pilot study.
  • +9
  • Arnaud Romeo Mbadjeu Hondjeu,
  • Azad Mashari,
  • Ryan Ramos,
  • Giulia Maria Ruggeri,
  • Joshua Qua Hiansen,
  • Bryan Gellner,
  • Roberto Vanin Pinto Ribeiro,
  • Frank Yu,
  • Liming Xin,
  • Mitchell Brady Adamson,
  • Mitesh Vallabh Badiwala,
  • Massimiliano Meineri
Arnaud Romeo Mbadjeu Hondjeu
University Health Network
Author Profile
Azad Mashari
University Health Network
Author Profile
Ryan Ramos
University Health Network
Author Profile
Giulia Maria Ruggeri
Toronto General Hospital
Author Profile
Joshua Qua Hiansen
University Health Network
Author Profile
Bryan Gellner
University of Toronto
Author Profile
Roberto Vanin Pinto Ribeiro
University of Toronto
Author Profile
Frank Yu
University Health Network
Author Profile
Liming Xin
University of Toronto
Author Profile
Mitchell Brady Adamson
University of Toronto
Author Profile
Mitesh Vallabh Badiwala
University Health Network
Author Profile
Massimiliano Meineri
Herzzentrum Leipzig Universitätsklinik
Author Profile

Abstract

Background Ex-situ heart perfusion (ESHP) has been developed to decrease cold ischemia time and allow metabolic assessment of donor’s hearts prior to transplantation. Current clinical ESHP systems preserve the heart in an unloaded condition and only evaluate the cardiac metabolic profile. In this pilot study we performed echocardiographic functional assessment using two alternative systems for left ventricular (LV) loading: Pump Supported Afterload Working Mode (SAM) and Passive Afterload Working Modes (PAM). Methods Six hearts were procured from male Yorkshire pigs. During cold ischemia, hearts were mounted on our custom made ESHP circuit and a 3D printed enclosure for the performance of echocardiography with a standard TEE probe. Following perfusion with Langherdorf mode of the unloaded heart, the system was switched into different working modes to allow LV loading and functional assessment: pump supported (SAM) and passive (PAM). Echocardiographic assessment of left ventricular function in the donor hearts was performed in vivo and at 1h of ESHP with SAM, after 4.5h with PAM and after 5.5h with SAM. Results We obtained good quality epicardial echocardiographic images at all time points allowing for comprehensive LV systolic assessment. All indices showed a decrease in LV systolic function throughout the trial with the biggest drop after heart harvesting. Conclusion We demonstrated the feasibility of echocardiographic functional assessment during ESHP and two different working modes. The expected LV systolic dysfunction consisted of a reduction in EF, FAC, FS, and Strain throughout the experiment with the most significant decrease after harvesting.