Electrophysiological Markers of Ex-Situ Heart Performance in a Porcine Model of Cardiac Donation After Circulatory Death

Transpl Int. 2024 Nov 20:37:13279. doi: 10.3389/ti.2024.13279. eCollection 2024.

Abstract

Normothermic ex-situ heart perfusion (ESHP) enables assessment of hearts donated after circulatory death (DCD) prior to transplantation. However, sensitive parameters of cardiac function of DCD hearts on ESHP are needed. This study proposes a novel approach using electrophysiological (EP) parameters derived from electrical mapping as biomarkers of post-ischemic cardiac performance. Porcine slaughterhouse hearts (PSH) were divided in two groups based on the type of warm ischemia (Group 1: 10 ± 1 min with animal depilation vs. Group 2: ≤5 min without depilation). Electrical mapping of the right (RV) and left ventricle (LV) was performed on ESHP. Potential voltages, slopes and conduction velocities were computed from unipolar electrograms and compared between groups. Voltages were lower in Group 1 compared to Group 2 (RV: 3.6 vs. 15.3 mV, p = 0.057; LV: 10.8 vs. 23.6 mV, p = 0.029). In addition, the percentage of low-voltage potentials was higher and potential slopes were flatter in Group 1. Voltages and slopes strongly correlated with the visual contractile performance of PSH, but showed weaker correlation with lactate profiles. In conclusion, unipolar potential voltages and potential slopes were decreased in hearts with severe warm ischemia. As such, EP parameters could aid transplantation teams in decision-making on transplantability of DCD hearts.

Keywords: cardiac transplantation; electrophysiological mapping; ex situ heart perfusion; graft assessment; machine perfusion.

MeSH terms

  • Animals
  • Heart / physiology
  • Heart / physiopathology
  • Heart Transplantation*
  • Heart Ventricles / physiopathology
  • Models, Animal
  • Organ Preservation / methods
  • Perfusion
  • Swine
  • Warm Ischemia

Grants and funding

The authors declare that no financial support was received for the research, authorship, and/or publication of this article.