Right Ventricular Distension in Donor Hearts Following Cardiocirculatory Death: Implications for Post-Transplant Function

Purpose Donation after cardiocirculatory death (DCD) may expand the donor pool for heart transplantation; however, right ventricular (RV) dysfunction has been observed in resuscitated DCD hearts and the cause of this is not well understood. We sought to characterize changes in RV pressure and volume following withdrawal of life-sustaining therapy (WLST) in a large animal model of DCD. Methods and Materials Thirteen pigs were anesthetized and mechanically ventilated with room air. Mechanical ventilation was discontinued, hypoxic cardiac arrest ensued, and a 10-minute standoff period was observed. Changes in RV pressure and volume were monitored using a conductance catheter and magnetic resonance imaging (MRI). Results The arterial partial pressure of oxygen decreased rapidly and reached its nadir after 2 minutes ( Figure 1 ). This corresponded with an increase in RV systolic pressure (baseline RVSP 24.1±0.9 vs. 35±2 mmHg, p min −172±24 vs. −267±24 mmHg/s, p max 254±32 vs. 378±32 mmHg/s, p=0.01) compared to baseline. Subsequent RV function progressively declined leading to an 18±6% (p Conclusions Following WLST the RV experiences significant distension that may exacerbate myocardial injury. Assessment of RV function prior to transplantation of the DCD heart is essential, highlighting the need for an ex vivo perfusion device capable of biventricular functional assessment.