Coronary Angiography and Intravascular Ultrasound in an Ex-Vivo Perfused Heart Using the Organ Care System (OCS)

Purpose To describe technical aspects of angiography and intravascular ultrasound (IVUS) in ex-vivo perfused hearts using the Organ Care System (OCS, TransMedics, Andover, MA USA). Methods During ex-vivo perfusion of a pig heart a moderate stenosis of the mid left anterior descending coronary artery (LAD) was created in order to test the sensitivity of angiography and IVUS. The operating table was removed and the OCS was lifted by 45 cm to achieve an AP position of the heart within the X-ray system. As tilted or rotated projections are limited by radiopaque materials within the OCS, the heart had to be rotated to facilitate different views. Results The standard heart position in the OCS revealed good visualization of the right coronary artery(RCA) using a 5 Fr. JR catheter (Fig 1). Using a JL catheter the left coronary artery(LCA) ostium could be intubated easily, however, visualization was suboptimal. Therefore the heart was rotated 90°-clockwise, which led to good LAD and suboptimal circumflex artery(RCx) visualization. 135°-anticlockwise-rotation(-45° from standard position) led to good LAD and RCx projection(Fig 2). The LAD stenosis could be visualized in the angiography and confirmed by IVUS. Conclusion Coronary angiogram of hearts during ex-vivo perfusion is feasible. As the OCS allows only AP fluoroscopy, the heart needs to be rotated to achieve sufficient views for coronary diagnostics. IVUS can be implemented to extend the diagnostic value.