Normothermic ex vivo perfusion provides superior organ preservation and enables viability assessment of hearts from DCD donors.

The shortage of donors in cardiac transplantation may be alleviated by the use of allografts from donation after circulatory death (DCD) donors. We have previously shown that hearts exposed to 30 min warm ischemic time and then flushed with Celsior supplemented with agents that activate ischemic postconditioning pathways, show complete recovery on a blood-perfused ex vivo working heart apparatus. In this study, these findings were assessed in a porcine orthotopic heart transplant model. DCD hearts were preserved with either normothermic ex vivo perfusion (NEVP) using a clinically approved device, or with standard cold storage (CS) for 4 h. Orthotopic transplantation into recipient animals was subsequently undertaken. Five of six hearts preserved with NEVP demonstrated favorable lactate profiles during NEVP and all five could be weaned off cardiopulmonary bypass posttransplant, compared with 0 of 3 hearts preserved with CS (p < 0.05, Fisher's exact test). In conclusion, DCD hearts flushed with supplemented Celsior solution and preserved with NEVP display viability before and after transplantation. Viability studies of human DCD hearts using NEVP are warranted.

Restoration of osmotically inhibited twitch force in rat cardiac trabeculae: role of Na+-H+ exchange.

1. When rat cardiac muscle is subjected to an increase of osmolality, its peak twitch force is immediately inhibited. Subsequently, over a period of several minutes, twitch force undergoes restoration, the extent of which is determined by the osmolality. The aim of the present study was to determine the factors that contribute to this restorative phenomenon. 2. Trabeculae were isolated from the right ventricles of rat hearts and mounted in an organ bath at 37 degrees C. The osmolality of the bathing solution was increased by 100 mOsmol (to 400 mOsmol) by the addition of various proportions of NaCl and sucrose while recording twitch force production. The role of Na+-H+ exchange in restoring twitch force was examined by use of the specific inhibitor cariporide (HOE 642). The role of Na+-Ca2+ exchange was examined by reducing [Ca2+]o (from 2 mmol/L to 0.5 mmol/L) or by substituting LiCl for NaCl. 3. Cariporide (25 micro mol/L) completely abolished twitch force restoration, thereby implicating a central role for the Na+-H+ exchanger. At constant [Na+]o, the extent of restoration was [Ca2+]o dependent, suggesting an independent contribution by the Na+-Ca2+ exchanger. This suggestion was supported by the finding that Li+, which substitutes for Na+ on the Na+-H+ exchanger, but not on the Na+-Ca2+ exchanger, also reduced the extent of restoration of hyperosmotically inhibited twitch force. 4. We conclude that the immediate inhibition of peak twitch force of rat cardiac muscle by hyperosmotic solutions reflects, in part, elevation of [H+]i, subsequent to reduction of cell volume. Hyperosmotic activation of Na+-H+ exchange then progressively relieves the inhibitory effect of protons on force development. The accompanying increase in [Na+]i in turn enhances Ca2+ influx on the Na+-Ca2+ exchanger, with the result that twitch force undergoes further restoration.