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Open Access 01-12-2013 | Review

Persufflation (gaseous oxygen perfusion) as a method of heart preservation

Authors: Thomas M Suszynski, Michael D Rizzari, William E Scott III, Peter M Eckman, James D Fonger, Ranjit John, Nicolas Chronos, Linda A Tempelman, David ER Sutherland, Klearchos K Papas

Published in: Journal of Cardiothoracic Surgery | Issue 1/2013

Abstract

Persufflation (PSF; gaseous oxygen perfusion) is an organ preservation technique with a potential for use in donor heart preservation. Improved heart preservation with PSF may improve outcomes by maintaining cardiac tissue quality in the setting of longer cold ischemia times and possibly increasing the number of donor hearts available for allotransplant. Published data suggest that PSF is able to extend the cold storage times for porcine hearts up to 14 hours without compromising viability and function, and has been shown to resuscitate porcine hearts following donation after cardiac death. This review summarizes key published work on heart PSF, including prospective implications and future directions for PSF in heart transplantation. We emphasize the potential impact of extending preservation times and expanding donor selection criteria in heart allotransplant. Additionally, the key issues that need to be addressed before PSF were to become a widely utilized preservation strategy prior to clinical heart transplantation are summarized and discussed.

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Taylor MJ, Baicu SC: Current state of hypothermic machine perfusion preservation of organs: the clinical perspective. Cryobiology. 2010, 60: S20-35. 10.1016/j.cryobiol.2009.10.006.CrossRefPubMed

Moers C, Smits JM, Maathuis MH, Treckmann J, van Gelder F, Napieralski BP, van Kasterop-Kutz M, van der Heide JJ, Squifflet JP, van Heurn E: Machine perfusion or cold storage in deceased-donor kidney transplantation. N Engl J Med. 2009, 360: 7-19. 10.1056/NEJMoa0802289.CrossRefPubMed

Kwiatkowski A, Wszola M, Kosieradzki M, Danielewicz R, Ostrowski K, Domagala P, Lisik W, Nosek R, Fesolowicz S, Trzebicki J: Machine perfusion preservation improves renal allograft survival. Am J Transplant. 2007, 7: 1942-1947. 10.1111/j.1600-6143.2007.01877.x.CrossRefPubMed

Hosgood SA, Yang B, Bagul A, Mohamed IH, Nicholson ML: A comparison of hypothermic machine perfusion versus static cold storage in an experimental model of renal ischemia reperfusion injury. Transplantation. 2010, 89: 830-837. 10.1097/TP.0b013e3181cfa1d2.CrossRefPubMed

Ciancio G, Gaynor JJ, Sageshima J, Chen L, Roth D, Kupin W, Guerra G, Tueros L, Zarak A, Hanson L: Favorable outcomes with machine perfusion and longer pump times in kidney transplantation: a single-center, observational study. Transplantation. 2010, 90: 882-890.CrossRefPubMed

Guarrera JV, Henry SD, Samstein B, Odeh-Ramadan R, Kinkhabwala M, Goldstein MJ, Ratner LE, Renz JF, Lee HT, Brown RS, Emond JC: Hypothermic machine preservation in human liver transplantation: the first clinical series. Am J Transplant. 2010, 10: 372-381. 10.1111/j.1600-6143.2009.02932.x.CrossRefPubMed

Young JB, Hauptman PJ, Naftel DC, Ewald G, Aaronson K, Dec GW, Taylor DO, Higgins R, Platt L, Kirklin J: Determinants of early graft failure following cardiac transplantation, a 10-year, multi-institutional, multivariable analysis. J Heart Lung Transplant. 2001, 20: 212-CrossRefPubMed

Kaczmarek I, Deutsch MA, Rohrer ME, Beiras-Fernandez A, Groetzner J, Daebritz S, Schmoeckel M, Spannagl M, Meiser B, Reichart B: HLA-DR matching improves survival after heart transplantation: is it time to change allocation policies?. J Heart Lung Transplant. 2006, 25: 1057-1062. 10.1016/j.healun.2006.05.004.CrossRefPubMed

Papas KK, Hering BJ, Guenther L, Rappel MJ, Colton CK, Avgoustiniatos ES: Pancreas oxygenation is limited during preservation with the two-layer method. Transplant Proc. 2005, 37: 3501-3504. 10.1016/j.transproceed.2005.09.085.CrossRefPubMed

10.

Weegman BP, Kirchner VA, Scott WE, Avgoustiniatos ES, Suszynski TM, Ferrer-Fabrega J, Rizzari MD, Kidder LS, Kandaswamy R, Sutherland DE, Papas KK: Continuous real-time viability assessment of kidneys based on oxygen consumption. Transplant Proc. 2010, 42: 2020-2023. 10.1016/j.transproceed.2010.05.082.CrossRefPubMedPubMedCentral

11.

Magnus R: Die Thätigkeit des überlebenden Säugethierherzens bei Durchströmung mit Gasen. Arch Exp Path Pharmakol. 1902, 47: 200-208. 10.1007/BF01929646.CrossRef

12.

Bunzl A, Burgen AS, Burns BD, Pedley N, Terroux KG: Methods for studying the reflex activity of the frog's spinal cord. Br J Pharmacol Chemother. 1954, 9: 229-235. 10.1111/j.1476-5381.1954.tb00846.x.CrossRefPubMedPubMedCentral

13.

Burns BD, Robson JG, Smith GK: The survival of mammalian tissues perfused with intravascular gas mixtures of oxygen and carbon dioxide. Can J Biochem Physiol. 1958, 36: 499-504. 10.1139/o58-056.CrossRefPubMed

14.

Sabiston DC, Talbert JL, Riley LH, Blalock A: Maintenance of the heart beat by perfusion of the coronary circulation with gaseous oxygen. Ann Surg. 1959, 150: 361-370. 10.1097/00000658-195909000-00004.CrossRefPubMedPubMedCentral

15.

Talbert JL, Riley LH, Sabiston DC, Blalock A: Retrograde perfusion of the coronary sinus with gaseous oxygen. Am Surg. 1960, 26: 189-192.PubMed

16.

Gott VL, Gonzalez JL, Zuhdi MN, Varco RL, Lillehei CW: Retrograde perfusion of the coronary sinus for direct vision aortic surgery. Surg Gynecol Obstet. 1957, 104: 319-328.PubMed

17.

Massimo C, Boffi L, Pozzi L: Sinusal standstill with ventricular automatism during retrograde perfusion of the coronary sinus under hypothermia for direct surgical approach to the aortic valves: an experimental study. J Thorac Surg. 1958, 36: 227-229.PubMed

18.

Camishion RC, Davies AL, Tokunaga K, Solit RW: Retrograde perfusion of the coronary arteries with gaseous oxygen cardiopulmonary bypass. Surgery. 1966, 59: 145-154.PubMed

19.

Barnard CN: The operation. A human cardiac transplant: an interim report of a successful operation performed at Groote Schuur Hospital, Cape Town. S Afr Med J. 1967, 41: 1271-1274.PubMed

20.

Gabel LP, Bihler I, Dresel PE: Contractility, metabolism and pharmacological reactions of isolated gas-perfused cat hearts. Circ Res. 1966, 19: 891-902. 10.1161/01.RES.19.5.891.CrossRefPubMed

21.

Lochner W, Arnold G, Muller-Ruchholtz ER: Metabolism of the artificially arrested heart and of the gas-perfused heart. Am J Cardiol. 1968, 22: 299-311. 10.1016/0002-9149(68)90114-8.CrossRefPubMed

22.

Denecke H: Recovery of the kidney from aerobic and anaerobic ischemia in deep hypothermia. Eur Surg Res. 1971, 3: 182-

23.

Kuhn-Regnier F, Fischer JH, Jeschkeit S: Coronary oxygen persufflation for long-term myocardial protection. Thorac Cardiovasc Surg. 1998, 46 (Suppl 2): 308-312.CrossRefPubMed

24.

Fischer JH, Kuhn-Regnier F, Jeschkeit S, Switkowski R, Bardakcioglu O, Sobottke R, Rainer de Vivie E: Excellent recovery after prolonged heart storage by preservation with coronary oxygen persufflation: orthotopic pig heart transplantations after 14-hr storage. Transplantation. 1998, 66: 1450-1459. 10.1097/00007890-199812150-00007.CrossRefPubMed

25.

Laine GA, Allen SJ: Left ventricular myocardial edema. Lymph flow, interstitial fibrosis, and cardiac function. Circ Res. 1991, 68: 1713-1721. 10.1161/01.RES.68.6.1713.CrossRefPubMed

26.

Kuhn-Regnier F, Fischer JH, Jeschkeit S, Switkowski R, Bardakcioglu O, Sobottke R, de Vivie ER: Coronary oxygen persufflation combined with HTK cardioplegia prolongs the preservation time in heart transplantation. Eur J Cardiothorac Surg. 2000, 17: 71-76. 10.1016/S1010-7940(99)00353-X.CrossRefPubMed

27.

Yotsumoto G, Jeschkeit-Schubbert S, Funcke C, Kuhn-Regnier F, Fischer JH: Total recovery of heart grafts of non-heart-beating donors after 3 hours of hypothermic coronary oxygen persufflation preservation in an orthotopic pig transplantation model. Transplantation. 2003, 75: 750-756. 10.1097/01.TP.0000055217.13736.9B.CrossRefPubMed

28.

Fischer J, Funcke C, Jeschkeit-Schubbert S, Yotsumoto G, Kuhn-Regnier F: Coronary endothelial function in heart grafts of non-heart-beating donors (NHBD) after 3 h hypothermic COP-preservation and orthotopic transplantation in pigs. Eur Surg Res. 2001, 33: 130-131.

29.

Kuhn-Regnier F, Bloch W, Tsimpoulis I, Reismann M, Dagktekin O, Jeschkeit-Schubbert S, Funcke C, Fries JW, Addicks K, de Vivie ER, Fischer JH: Coronary oxygen persufflation for heart preservation in pigs: analyses of endothelium and myocytes. Transplantation. 2004, 77: 28-35. 10.1097/01.TP.0000090162.96787.D0.CrossRefPubMed

30.

Fischer JH, Funcke C, Yotsumoto G, Jeschkeit-Schubbert S, Kuhn-Regnier F: Maintenance of physiological coronary endothelial function after 3.3 h of hypothermic oxygen persufflation preservation and orthotopic transplantation of non-heart-beating donor hearts. Eur J Cardiothorac Surg. 2004, 25: 98-104. 10.1016/S1010-7940(03)00673-0.CrossRefPubMed

31.

Fischer JH: Methods of Cardiac Oxygen Persufflation. Organ Preservation and Reengineering. Edited by: Uygun K, Lee CY. 2011, Boston: Artech House Publisher, 105-126.

32.

Flatmark A, Slaattelid O, Woxholt G: Gaseous persufflation during machine perfusion of human kidneys before transplantation. Eur Surg Res. 1975, 7: 83-90.CrossRefPubMed

33.

Treckmann J, Minor T, Saad S, Ozcelik A, Malago M, Broelsch CE, Paul A: Retrograde oxygen persufflation preservation of human livers: a pilot study. Liver Transpl. 2008, 14: 358-364. 10.1002/lt.21373.CrossRefPubMed

34.

Scott WE, O'Brien TD, Ferrer-Fabrega J, Avgoustiniatos ES, Weegman BP, Anazawa T, Matsumoto S, Kirchner V, Rizzari M, Murtaugh MP: Persufflation improves pancreas preservation when compared with the two-layer method (TLM). Transplant Proc. 2010, 42: 2016-2019. 10.1016/j.transproceed.2010.05.092.CrossRefPubMedPubMedCentral

35.

Scott WE, Weegman BP, Ferrer-Fabrega J, Stein SA, Anazawa T, Kirchner V, Rizzari M, Stone J, Matsumoto S, Hammer BE: Pancreas oxygen persufflation increases ATP levels as shown by nuclear magnetic resonance. Transplant Proc. 2010, 42: 2011-2015. 10.1016/j.transproceed.2010.05.091.CrossRefPubMedPubMedCentral

36.

Ferrari P, de Klerk M: Paired kidney donations to expand the living donor pool. J Nephrol. 2009, 22: 699-707.PubMed

37.

Delmonico FL, Sheehy E, Marks WH, Baliga P, McGowan JJ, Magee JC: Organ donation and utilization in the United States, 2004. Am J Transplant. 2005, 5: 862-873. 10.1111/j.1600-6135.2005.00832.x.CrossRefPubMed

38.

Metzger RA, Delmonico FL, Feng S, Port FK, Wynn JJ, Merion RM: Expanded criteria donors for kidney transplantation. Am J Transplant. 2003, 3 (Suppl 4): 114-125.CrossRefPubMed

39.

Ojo AO, Heinrichs D, Emond JC, McGowan JJ, Guidinger MK, Delmonico FL, Metzger RA: Organ donation and utilization in the USA. Am J Transplant. 2004, 4 (Suppl 9): 27-37.CrossRefPubMed

40.

Roodnat JI, Kal-van Gestel JA, Zuidema W, van Noord MA, van de Wetering J, IJzermans JN, Weimar W: Successful expansion of the living donor pool by alternative living donation programs. Am J Transplant. 2009, 9: 2150-2156. 10.1111/j.1600-6143.2009.02745.x.CrossRefPubMed

41.

Segev DL, Kucirka LM, Gentry SE, Montgomery RA: Utilization and outcomes of kidney paired donation in the United States. Transplantation. 2008, 86: 502-510.CrossRefPubMed

42.

Ojo AO, Hanson JA, Meier-Kriesche H, Okechukwu CN, Wolfe RA, Leichtman AB, Agodoa LY, Kaplan B, Port FK: Survival in recipients of marginal cadaveric donor kidneys compared with other recipients and wait-listed transplant candidates. J Am Soc Nephrol. 2001, 12: 589-597.PubMed

43.

Arata K, Iguro Y, Yotsumoto G, Ueno T, Terai H, Sakata R: Use of continuous retrograde gaseous oxygen persufflation for myocardial protection during open heart surgery. Surg Today. 2010, 40: 549-554. 10.1007/s00595-008-4093-z.CrossRefPubMed

Title: Persufflation (gaseous oxygen perfusion) as a method of heart preservation
Authors: Thomas M Suszynski
Michael D Rizzari
William E Scott III
Peter M Eckman
James D Fonger
Ranjit John
Nicolas Chronos
Linda A Tempelman
David ER Sutherland
Klearchos K Papas
Publication date: 01-12-2013
Publisher: BioMed Central
Published in: Journal of Cardiothoracic Surgery / Issue 1/2013
Electronic ISSN: 1749-8090
DOI: https://doi.org/10.1186/1749-8090-8-105

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Persufflation (gaseous oxygen perfusion) as a method of heart preservation

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