BACKGROUND The optimal blood flow and pressure to perfuse pediatric hearts from donation after circulatory death (DCD) on the ex vivo perfusion system has not been elucidated. This study sought to investigate the optimal perfusion strategy for pediatric DCD hearts by using a juvenile porcine model comparing pressure- vs flow-targeted strategy. METHODS The hearts of the juvenile DCD pigs were explanted, and the coronary arteries were perfused for 2 hours by the ex vivo heart perfusion system with 2 different perfusion strategies; pressure-targeted perfusion (target coronary perfusion pressure: 40 mm Hg, group A) and flow-targeted perfusion (target coronary perfusion flow: 10 ml/kg/min, group B). The working model heart perfusion was used to assess systolic and diastolic myocardial performance. RESULTS The body weight, warm and cold ischemic time, and ex vivo perfusion time were comparable between the groups. In the working model, group B showed significantly preserved cardiac output (A: 70.5 ± 15.3 ml/kg/min vs B: 113.8 ± 15.0 ml/kg/min, p < 0.01), stroke volume (A: 0.4 ± 0.1 ml/kg vs B: 0.7 ± 0.1 ml/kg, p < 0.01), and ejection fraction (A: 18.8% ± 5.9% vs B: 35.0% ± 10.6%, p < 0.01). E/e' and Tei index were also significantly preserved in group B. The percentage gain of heart weight after ex vivo (net increase of the heart weight divided by heart weight at baseline) was significantly smaller in group B (A: 20.0% ± 5.3% vs B: 11.6% ± 5.0%, p < 0.05). Troponin-I, myocardial hemorrhage, oxidative stress markers; myeloperoxidase and 8-hydroxy-2'-deoxyguanosine were also significantly lower after ex vivo perfusion in group B (p < 0.05). CONCLUSIONS The tightly controlled flow-targeted myocardial perfusion strategy for DCD donor hearts achieved better myocardial performance by causing less myocardial edema and limiting myocardial reperfusion injury.

中文翻译：

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循环死亡后捐献中以血流为目标的小儿离体心脏灌注：猪模型。

背景技术尚未阐明在体外灌注系统上从循环死亡（DCD）后的捐赠中灌注小儿心脏的最佳血流量和压力。这项研究试图通过使用比较压力和流量目标策略的少年猪模型来研究小儿DCD心脏的最佳灌注策略。方法采用体外心脏灌注系统，采用两种不同的灌注策略，对幼龄DCD猪的心脏进行移植，并对冠状动脉进行2小时的灌注。以压力为目标的灌注（目标冠状动脉灌注压力：40 mm Hg，A组）和以流量为目标的灌注（目标冠状动脉灌注流量：10 ml / kg / min，B组）。工作模型心脏灌注用于评估收缩和舒张心肌性能。结果体重，冷热缺血时间，两组之间的体外和体外灌注时间相当。在工作模型中，B组显示出显着保留的心输出量（A：70.5±15.3 ml / kg / min，而B：113.8±15.0 ml / kg / min，p <0.01），中风量（A：0.4±0.1 ml / min kg vs B：0.7±0.1 ml / kg，p <0.01）和射血分数（A：18.8％±5.9％vs B：35.0％±10.6％，p <0.01）。B组中E / e'和Tei指数也得到了显着保留。离体后心脏重量的百分比增加（净体重的净增加除以基线时的心脏重量）在B组中明显较小（A：20.0％±相对于B：5.3％：11.6％±5.0％，p <0.05）。肌钙蛋白-I，心肌出血，氧化应激标志物；B组离体灌注后，髓过氧化物酶和8-羟基-2'-脱氧鸟苷也显着降低（p <0.05）。