Akhil Basani
Research Mentor(s): Alvaro Rojas-Peña
Mentor Department: Department of Surgery-Transplantation
Authors: Akhil Basani, Wyeth Alexander, Vikramjit Chakrabortty, Takahiro Nakashima, Robert H Bartlett , Daniel H Drake, Alvaro Rojas-Pena
Session: Session 1 (9:00am – 9:50am)
Presentation Type: Poster 40
Abstract
Introduction: Clinical applications of normothermic ex-vivo heart perfusion (NEHP) systems are limited to 6-8 hours. Previous studies have shown that NEHP with plasma cross circulation via paracorporeal animals drastically prolongs NEHP allograft viability. This study aimed to compare NEHP allograft preservation when supplemented with fractionated plasma alone (SF65 or SF120) or unfractionated plasma combined with plasma filtration. Methods: Hearts were procured from juvenile yorkshire pigs (51.3 ± 5.6 kg) following standard procurement protocols. Back table heart preparation included placement of 1) aortic infusion cannula 2) 16Fr left atrial infusion (LA) cannula 3) 20Fr pulmonary artery (PA) drainage cannula 4) 12 Fr left ventricular (LV) venting cannula 5) LA pressure monitoring. Hearts were perfused with an oxygenated cellular perfusate (Hgb 8.0-10.5 g/dL) in a retrograde fashion through the aortic cannula viA Langendorff perfusion at 0.6 cc/g/min. Perfusate was supplemented to maintain physiologic electrolytes. Vasoactive medications were utilized to maintain a mean arterial pressure (MAP) of 30-50 mmHg as needed. Allografts were further treated based on their treatment group: SF65: Infusion of fractionated donor plasma to include proteins <65kDa and continuous hemofiltration SF120: Infusion of fractionated donor plasma to include proteins <120kDa and continuous hemofiltration Plasma Exchange (PE): Infusion of unfractionated donor plasma, continuous plasma filtration, and intermittent hemofiltration for maintenance of electrolytes Data recording included: q30min hemodynamic assessment, q1Hr ABG/VBG, q6 CBC and CHEM17, and q24hr echocardiography with intermittent left atrial perfusion (ILA). The purpose of supplementing NEHP hearts with fractionated plasma alone (SF65 and SF120) or unfractionated plasma combined with plasma filtration is to assess what proteins help heart function and viability over 48 hours. By supplementing hearts with plasma of different sizes of proteins, we aim to elucidate what proteins best support heart function to prolong NEHP organ preservation for transplantation.
