Cardiac function unchanged following reanimation with normothermic regional perfusion in donation after circulatory death

Nicholas W Markin; M Megan Chacon; Anthony W Castleberry; Lance Fristoe; Brian D Lowes; John Y Um; Marian Urban

doi:10.1016/j.xjtc.2022.07.018

Cardiac function unchanged following reanimation with normothermic regional perfusion in donation after circulatory death

JTCVS Tech. 2022 Aug 7:15:136-143. doi: 10.1016/j.xjtc.2022.07.018. eCollection 2022 Oct.

Authors

Nicholas W Markin¹, M Megan Chacon¹, Anthony W Castleberry², Lance Fristoe³, Brian D Lowes⁴, John Y Um², Marian Urban²

Affiliations

¹ Division of Cardiac Anesthesiology, Department of Anesthesiology, College of Medicine, University of Nebraska Medical Center, Omaha, Neb.
² Division of Cardiothoracic Surgery, Department of Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, Neb.
³ Department of Perfusion Services, Nebraska Medicine, Omaha, Neb.
⁴ Division of Cardiology, Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, Neb.

Abstract

Objectives: To determine whether hearts reanimated with normothermic regional perfusion (NRP) have clinically detectable changes in function using echocardiography comparing the prearrest and post-NRP imaging. As heart transplantation from donation after circulatory death (DCD) continues to increase, preliminary results suggest outcomes comparable with donation after brain death. It is unknown whether the obligatory period of warm ischemia experienced during DCD withdrawal process causes immediate changes in cardiac allograft function following in situ reanimation.

Methods: We retrospectively reviewed and compared predonation with postreanimation echocardiographic findings in all DCD donors at our institution from January to October 2021. All DCD donor organs were reanimated with in situ thoracoabdominal NRP after circulatory death. Echocardiographic assessment included (1) 2-dimensional and speckle-tracking measures of chamber size and function; (2) ejection fraction; (3) fractional area change; and (4) global longitudinal strain.

Results: Altogether, 4 DCD heart donations were performed during the study period. Basic demographics and withdrawal ischemic time periods are reported. There were no changes in left ventricular ejection fraction and right ventricular fractional area change when comparing the predonation and the postreanimation echocardiogram. There was a minimal, nonstatistically significant decrease in left ventricular global longitudinal strain and right ventricular free-wall systolic strain in 3 of the 4 donors following reanimation.

Conclusions: DCD cardiac allografts reanimated with NRP demonstrated no change in echocardiographic parameters used for a standard predonation donor heart evaluation. Findings suggest cardiac function of DCD allografts reanimated with thoracoabdominal NRP is not adversely impacted by limited period of warm ischemia following circulatory arrest.

Keywords: DCD, donation after cardiac death; GLS, global longitudinal strain; LV, left ventricle; NRP, normothermic regional perfusion; RV, right ventricle/ventricular; TA, thoracoabdominal; TEE, transesophageal echocardiography; TTE, transthoracic echocardiography; donation after circulatory death; echocardiography; heart transplantation; strain.