Comparing Donor Heart Assessment Strategies During Ex Situ Heart Perfusion to Better Estimate Post-Transplant Cardiac Function.

Background. Ex situ heart perfusion (ESHP) limits ischemic periods and enables continuous monitoring of donated hearts; however, a validated assessment method to predict cardiac performance has yet to be established. We compare biventricular contractile and metabolic parameters measured during ESHP to determine the best evaluation strategy to estimate cardiac function following transplantation. Methods. Donor pigs were assigned to undergo beating-heart donation (n = 9) or donation after circulatory death (n = 8) induced by hypoxia. Hearts were preserved for 4 hours with ESHP while invasive and noninvasive (NI) biventricular contractile, and metabolic assessments were performed. Following transplantation, hearts were evaluated at 3 hours of reperfusion. Spearman correlation was used to determine the relationship between ESHP parameters and posttransplant function. Results. We performed 17 transplants; 14 successfully weaned from bypass (beating-heart donation versus donation after circulatory death;P= 0.580). Left ventricular invasive preload recruitable stroke work (PRSW) (r= 0.770;P= 0.009), NI PRSW (r= 0.730;P= 0.001), and NI maximum elastance (r= 0.706;P= 0.002) strongly correlated with cardiac index (CI) following transplantation. Right ventricular NI PRSW moderately correlated to CI following transplantation (r= 0.688;P= 0.003). Lactate levels were weakly correlated with CI following transplantation (r= -0.495;P= 0.043). None of the echocardiography measurements correlated with cardiac function following transplantation. Conclusions. Left ventricular functional parameters, especially ventricular work and reserve, provided the best estimation of myocardial performance following transplantation. Furthermore, simple NI estimates of ventricular function proved useful in this setting. Right ventricular and metabolic measurements were limited in their ability to correlate with myocardial recovery. This emphasizes the need for an ESHP platform capable of assessing myocardial contractility and suggests that metabolic parameters alone do not provide a reliable evaluation.