Madeline Fournier
Pronouns: she/her
Research Mentor(s): Alvaro Rojas-Peña
Research Mentor School/College/Department: Department of Surgery-Transplantation / Medicine
Program:
Authors: Madeline Fournier, Wyeth Alexander, Vikramjit Chakrabortty , Kristopher Urrea, Takahiro Nakashima , Daniel Drake, Robert Bartlett, Alvaro Rojas-Pena
Session: Session 6: 3:40 pm – 4:30 pm
Poster: 8
Abstract
Prolonged Normothermic Ex-Vivo Perfusion (NEHP) is an innovative technology with potential to expand the temporal and geographical organ donor pool, allow for assessment of marginal hearts, and offers potential for organ immunomodulation prior to implantation. In clinical practice, NEHP systems are currently limited to 6-10 hours with an incomplete understanding of ideal NEHP management parameters. The goal of this current study is to determine the optimal coronary perfusion flow rate for successfully prolonging ex-vivo tissue perfusion. Nine adult-size pigs (40–60 kg) were instrumented under general anesthesia. The hearts were exposed via a midline thoracotomy and cold cardioplegia was administered prior to organ procurement. Back table heart preparation: placement of an aortic cannula, PA drainage cannula, LA perfusion cannula, LA pressure monitor cannula, and LV drainage cannula. The hearts were perfused in a Langendorff perfusion mode and managed with hemofiltration and electrolyte replacement. Experimental groups: 3 hearts perfused at 1.5 cc/g of cardiac tissue/min, 3 hearts at 0.75 cc/g of cardiac tissue/min, and 3 hearts at 0.25 cc/g of cardiac tissue/min. Data collection: Q30min hemodynamic monitoring, Q1hour ABGs/VBGs, Q6hour LA perfusion testing with hemodynamic monitoring, Q24hour echocardiogram, final pathology, dry/wet weight ratios. Preliminary results demonstrate high flow hearts are associated with improved tissue quality grossly and reduced rates of valvular insufficiency, however are associated with increased septal wall edema on echocardiogram. Inversely, low flow hearts are associated with reduced septal wall edema at the expense of gross tissue viability, subjective organ contractility, and increased rates of valvular insufficiency. High coronary flow rates provide better tissue perfusion at the expense of coronary wall edema while low coronary flow rates provide a better edema profile at the expense of tissue viability. Further work will be conducted to characterize ideal coronary flow rates.
