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Eur J Cardiothorac Surg 2008;34:318-325. doi:10.1016/j.ejcts.2008.03.043
Copyright © 2008, European Association for Cardio-thoracic Surgery. Published by Elsevier. All rights reserved.
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Michael J. Collins
Sina L. Moainie
Bartley P. Griffith
Robert S. Poston
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Preserving and evaluating hearts with ex vivo machine perfusion: an avenue to improve early graft performance and expand the donor pool

Michael J. Collins, Sina L. Moainie, Bartley P. Griffith, Robert S. Poston*

Division of Cardiac Surgery, Department of Surgery, University of Maryland Medical Center, N4W94 22 S. Greene St., Baltimore, MD, 21201, United States

Received 14 September 2007; received in revised form 4 March 2008; accepted 6 March 2008.

* Corresponding author. Tel.: +1 617 638 7350; fax: +1 617 638 7228. (Email: robert.poston{at}bmc.org).

Cardiac transplantation remains the first choice for the surgical treatment of end stage heart failure. An inadequate supply of donor grafts that meet existing criteria has limited the application of this therapy to suitable candidates and increased interest in extended criteria donors. Although cold storage (CS) is a time-tested method for the preservation of hearts during the ex vivo transport interval, its disadvantages are highlighted in hearts from the extended criteria donor. In contrast, transport of high-risk hearts using hypothermic machine perfusion (MP) provides continuous support of aerobic metabolism and ongoing washout of metabolic byproducts. Perhaps more importantly, monitoring the organ's response to this intervention provides insight into the viability of a heart initially deemed as extended criteria. Obviously, ex vivo MP introduces challenges, such as ensuring homogeneous tissue perfusion and avoiding myocardial edema. Though numerous groups have experimented with this technology, the best perfusate and perfusion parameters needed to achieve optimal results remain unclear. In the present review, we outline the benefits of ex vivo MP with particular attention to how the challenges can be addressed in order to achieve the most consistent results in a large animal model of the ideal heart donor. We provide evidence that MP can be used to resuscitate and evaluate hearts from animal and human extended criteria donors, including the non-heart beating donor, which we feel is the most compelling argument for why this technology is likely to impact the donor pool.

Abbreviations: MP = machine perfusion • CS = cold storage • NHBD = non-heart beating donor

Key Words: Non-heart beating donor • Myocardial viability • Machine perfusion • Heart transplantation • Myocardial preservation






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Copyright © 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier. All rights reserved.