Attenuated cardiac function degradation in ex vivo pig hearts

Benjamin Kappler (Corresponding author), Sjoerd van Tuijl, Bülent Ergin, Louis Fixsen, Marco Stijnen, Can Ince, Bas A.J.M. de Mol

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Abstract

Isolated hearts offer the opportunity to evaluate heart function, treatments, and diagnostic tools without in vivo factor interference. However, the early loss of cardiac function and edema occur over time and do limit the duration of the experiment. This research focuses on delaying these limitations using optimal blood control. This study examines whether blood conditioning by means of the combination of blood predilution and hemodialysis can significantly reduce cardiac function degradation. Slaughterhouse porcine hearts were revived in the PhysioHeart™ platform to restore physiological cardiac performance. Twelve hearts were divided into a control group and a dialysis group; in the latter group, hemodialysis was attached to the blood reservoir. Cardiac hemodynamics and blood parameters were recorded and evaluated. Blood conditioning significantly reduced the loss of cardiac pump function (control group vs dialysis group, −14.9 ± 6.3%/h vs −9.7 ± 2.7%/h) and loss of cardiac output (control group vs dialysis group, −11.8 ± 3.4%/h vs −5.9 ± 2.0%/h). Hemodialysis resulted in physiological and stable blood parameters, whereas in the control group ions reached pathological values, while interstitial edema still occurred. The combination of blood predilution and hemodialysis significantly attenuated ex vivo cardiac function degradation and delayed the loss of cardiac hemodynamics. We hypothesized that besides electrolyte and metabolic control, the hemodialysis-accompanied increase in hematocrit resulted in improved oxygen transport. This could have temporarily compensated the deleterious effect of an increased oxygen-diffusion distance due to edema in the dialysis group and resulted in less progression of cell decay. Clinically validated measures delaying edema might improve the effectiveness of the PhysioHeart™ platform.

Original languageEnglish
Pages (from-to)173-179
Number of pages7
JournalInternational Journal of Artificial Organs
Volume43
Issue number3
Early online date17 Oct 2019
DOIs
Publication statusPublished - 1 Mar 2020

Funding

https://orcid.org/0000-0001-6816-3162 Kappler Benjamin 1 2 van Tuijl Sjoerd 2 Ergin Bülent 3 Fixsen Louis 4 Stijnen Marco 2 Ince Can 3 de Mol Bas AJM 1 2 1 Department of Cardiothoracic Surgery, AMC Heart Center, Amsterdam University Medical Center—Location AMC, Amsterdam, The Netherlands 2 LifeTec Group BV, Eindhoven, The Netherlands 3 Department of Translational Physiology, Amsterdam University Medical Center—Location AMC, Amsterdam, The Netherlands 4 Cardiovascular Biomechanics Group, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands Benjamin Kappler, Department of Cardiothoracic Surgery, AMC Heart Center, Amsterdam University Medical Center—Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Email: b.kappler@amc.uva.nl 10 2019 0391398819879706 6 4 2019 10 9 2019 © The Author(s) 2019 2019 SAGE Publications Isolated hearts offer the opportunity to evaluate heart function, treatments, and diagnostic tools without in vivo factor interference. However, the early loss of cardiac function and edema occur over time and do limit the duration of the experiment. This research focuses on delaying these limitations using optimal blood control. This study examines whether blood conditioning by means of the combination of blood predilution and hemodialysis can significantly reduce cardiac function degradation. Slaughterhouse porcine hearts were revived in the PhysioHeart™ platform to restore physiological cardiac performance. Twelve hearts were divided into a control group and a dialysis group; in the latter group, hemodialysis was attached to the blood reservoir. Cardiac hemodynamics and blood parameters were recorded and evaluated. Blood conditioning significantly reduced the loss of cardiac pump function (control group vs dialysis group, −14.9 ± 6.3%/h vs −9.7 ± 2.7%/h) and loss of cardiac output (control group vs dialysis group, −11.8 ± 3.4%/h vs −5.9 ± 2.0%/h). Hemodialysis resulted in physiological and stable blood parameters, whereas in the control group ions reached pathological values, while interstitial edema still occurred. The combination of blood predilution and hemodialysis significantly attenuated ex vivo cardiac function degradation and delayed the loss of cardiac hemodynamics. We hypothesized that besides electrolyte and metabolic control, the hemodialysis-accompanied increase in hematocrit resulted in improved oxygen transport. This could have temporarily compensated the deleterious effect of an increased oxygen-diffusion distance due to edema in the dialysis group and resulted in less progression of cell decay. Clinically validated measures delaying edema might improve the effectiveness of the PhysioHeart™ platform. Ex vivo hemodialysis cardiac hemoperfusion edited-state corrected-proof Declaration of conflicting interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project has received funding from the European Union’s Horizon 2020 research and innovation program under the Marie Sklodowska Curie grant agreement no. 642612. ORCID iD Benjamin Kappler https://orcid.org/0000-0001-6816-3162 The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project has received funding from the European Union?s Horizon 2020 research and innovation program under the Marie Sklodowska Curie grant agreement no. 642612.

FundersFunder number
European Union 's Horizon 2020 - Research and Innovation Framework Programme
Horizon 2020 Framework Programme642612
Marie Skłodowska‐Curie

    Keywords

    • cardiac hemoperfusion
    • Ex vivo
    • hemodialysis

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