ArticleASAIO journal (American Society for Artificial Internal Organs : 1992)2026
Extending Normothermic Ex Situ Heart Preservation and Viability to 48 Hours via Protein Supplementation and Plasma Exchange.
Article in ASAIO journal (American Society for Artificial Internal Organs : 1992), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Prolonged normothermic ex situ heart perfusion (NEHP) could expand the donor pool by decoupling procurement, transport, and implantation, but clinically used systems rarely exceed 4-6 hours. We evaluated pragmatic protein replacement strategies enabling 48-hour NEHP in adult porcine hearts without biologic cross-circulation. Thirteen juvenile pigs (50.6 ± 5.0 kg) underwent Langendorff NEHP and were randomly assigned to 65 kDa serum fractionate (SF65; n = 5), continuous infusion of serum fractionated to <65 kDa with hemofiltration; 120 kDa serum fractionate (SF120; n = 3), consisting of serum fractionated to <120 kDa with hemofiltration; or plasma exchange (PE, n = 5), consisting of unfractionated plasma with concomitant plasma filtration and intermittent hemofiltration. Hearts were perfused for 48 hours with intermittent working-mode assessments under predefined failure criteria. All hearts completed 48 hours without failure. PE demonstrated the lowest coronary resistance at 37-48 hours (0.13 ± 0.05 vs. 0.30 ± 0.13 SF65, 0.69 ± 0.31 SF120 mm Hg/ml/min); SF120 exhibited markedly higher aortic regurgitation (38.1% ± 27.7% vs. 5.7% ± 4.9% SF65, 5.0% ± 6.7% PE); SF65 showed the greatest edema (interventricular septal wall diameter [IVSd] increase 102% ± 23% vs. 37% ± 17% SF120, 33% ± 19% PE); and echocardiographic indices and composite histologic injury scores were similar among groups. Reproducible 48-hour NEHP of adult porcine hearts is feasible using clinically accessible protein replacement strategies. PE approximates the benefits of fractionated serum regimens while avoiding large-protein accumulation and represents a practical path toward translational long-duration heart perfusion.
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