Title : Ex-situ organ perfusion and cardiac performance improvement
Abstract:
Cardiac transplantation remains the golden standard for patients with end-stage heart failure when therapeutic approaches and interventions fail to reverse HF progression. Traditionally, hearts are transplanted from brain-death (DBD) donors where the heart is beating at time of procurement and cardiac arrest is controlled, enabling immediate cardio protection of the donor heart from start of the procedure. However, the worldwide shortage in donor hearts for transplantation persists and the number of patients with end-stage HF is still increasing. DCD hearts provide an additional donor pool, but these hearts can only be procured after cardiac arrest of the donor, resulting in warm ischemia of the organ before cardioplegic protection. In order to use such hearts, a perfusion intermediate is needed where, worldwide, only 1 commercially available heart perfusion machine is available dictating warm perfusion. Despite the increase in number of transplantations, several inconsistencies still exist in terms of supraphysiological coronary blood flow on machine perfusion, perfusate composition, optimal preservation temperature and how to objectively measure allograft quality and viability.
In such, our lab focusses on: a) determining improved cardiac perfusion strategies, b) optimization of perfusion hemodynamics, c) altering cardiac performance, and d) defining optimal real-time biofeedback on allograft viability. This presentation addresses our experiences with the DCD program and pinpoints specific obstacles. Next, novel therapies and modifications will be discussed to improve cardiac function and longevity, including alternative perfusion modalities. Finally, results from our unique real-time biofeedback system on allograft functionality will be discussed to allow for patient-tailored medicine.
