FLOW-TARGETED PEDIATRIC EX-VIVO HEART PERFUSION in DONATION AFTER CIRCULATORY DEATH: A Porcine Model

ABSTRACT Objectives The optimal blood flow and pressure to perfuse pediatric hearts donation after circulatory death (DCD) on the ex-vivo perfusion system has not been elucidated. This study sought to investigate the optimal perfusion strategy for pediatric DCD hearts by using a juvenile porcine model comparing pressure- vs. flow-targeted strategy. Methods The hearts of the juvenile DCD pigs were explanted and the coronary arteries were perfused for 2 hours by the ex-vivo heart perfusion system with two different perfusion strategies; pressure-targeted perfusion (target coronary perfusion pressure: 40mmHg, group A) and flow-targeted perfusion (target coronary perfusion flow: 10ml/kg/min, group B). The working model heart perfusion was used to assess systolic and diastolic myocardial performance. Results Body weight, warm and cold ischemic time, and ex-vivo perfusion time were comparable between the groups. In the working model, group B showed significantly preserved cardiac output (A: 70.5+/-15.3ml/kg/min vs. B: 113.8+/-15.0ml/kg/min, p Conclusions The tightly-controlled flow-targeted myocardial perfusion strategy for DCD donor hearts achieved better myocardial performance by causing less myocardial edema and limiting myocardial reperfusion injury.