Jorik H Amesz, Mark F A Bierhuizen, Sanne J J Langmuur, Paul Knops, Yvar P van Steenis, Dwight Dumay, Mathijs S van Schie, Olivier C Manintveld, Natasja M S de Groot, Yannick J H J Taverne
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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.
常温离体心脏灌注（ESHP）可以评估移植前循环死亡（DCD）后捐赠的心脏。然而，需要对DCD心脏的ESHP进行敏感的心功能参数测定。本研究提出了一种使用电生理（EP）参数作为缺血后心脏表现的生物标志物的新方法。猪屠宰场心脏（PSH）根据热缺血类型分为两组（1组：10±1 min伴有动物脱毛，2组：≤5 min不脱毛）。在ESHP上进行右心室和左心室的电图绘制。从单极电图中计算电位电压、斜率和传导速度，并比较各组之间的差异。组1电压较组2低(RV: 3.6 vs. 15.3 mV, p = 0.057；低压：10.8 vs. 23.6 mV, p = 0.029)。此外，1组的低压电位百分比更高，电位斜率更平坦。电压和坡度与PSH的视觉收缩性能密切相关，但与乳酸曲线相关性较弱。综上所述，严重热缺血时心脏单极电位电压和电位斜率降低。因此，EP参数可以帮助移植团队对DCD心脏的可移植性进行决策。
期刊介绍：
The aim of the journal is to serve as a forum for the exchange of scientific information in the form of original and high quality papers in the field of transplantation. Clinical and experimental studies, as well as editorials, letters to the editors, and, occasionally, reviews on the biology, physiology, and immunology of transplantation of tissues and organs, are published. Publishing time for the latter is approximately six months, provided major revisions are not needed. The journal is published in yearly volumes, each volume containing twelve issues. Papers submitted to the journal are subject to peer review.
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