Open- vs. closed-chest pig models of donation after circulatory death.

Autor:	Hubacher V; Department of Cardiac Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland., Egle M; Department of Cardiac Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.; Department for BioMedical Research, University of Bern, Bern, Switzerland.; Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland., Graf S; Department of Cardiac Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.; Department for BioMedical Research, University of Bern, Bern, Switzerland.; Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland., Arnold M; Department of Cardiac Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.; Department for BioMedical Research, University of Bern, Bern, Switzerland., Segiser A; Department of Cardiac Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.; Department for BioMedical Research, University of Bern, Bern, Switzerland., Sanz MN; Department of Cardiac Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.; Department for BioMedical Research, University of Bern, Bern, Switzerland., Casoni D; Experimental Surgery Facility (ESF), Experimental Animal Center, Faculty of Medicine, University of Bern, Bern, Switzerland., Garcia Casalta L; Experimental Surgery Facility (ESF), Experimental Animal Center, Faculty of Medicine, University of Bern, Bern, Switzerland., Nettelbeck K; Experimental Surgery Facility (ESF), Experimental Animal Center, Faculty of Medicine, University of Bern, Bern, Switzerland., Mihalj M; Department of Cardiac Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.; Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Texas Medical Center, Houston, TX, United States., Siepe M; Department of Cardiac Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland., Kadner A; Department of Cardiac Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland., Longnus S; Department of Cardiac Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.; Department for BioMedical Research, University of Bern, Bern, Switzerland.
Jazyk:	angličtina
Zdroj:	Frontiers in cardiovascular medicine [Front Cardiovasc Med] 2024 Jun 13; Vol. 11, pp. 1325160. Date of Electronic Publication: 2024 Jun 13 (Print Publication: 2024).
DOI:	10.3389/fcvm.2024.1325160
Abstrakt:	Background: During donation after circulatory death (DCD), cardiac grafts are exposed to potentially damaging conditions that can impact their quality and post-transplantation outcomes. In a clinical DCD setting, patients have closed chests in most cases, while many experimental models have used open-chest conditions. We therefore aimed to investigate and characterize differences in open- vs. closed-chest porcine models. Methods: Withdrawal of life-sustaining therapy (WLST) was simulated in anesthetized juvenile male pigs by stopping mechanical ventilation following the administration of a neuromuscular block. Functional warm ischemic time (fWIT) was defined to start when systolic arterial pressure was <50 mmHg. Hemodynamic changes and blood chemistry were analyzed. Two experimental groups were compared: (i) an open-chest group with sternotomy prior to WLST and (ii) a closed-chest group with sternotomy after fWIT. Results: Hemodynamic changes during the progression from WLST to fWIT were initiated by a rapid decline in blood oxygen saturation and a subsequent cardiovascular hyperdynamic (HD) period characterized by temporary elevations in heart rates and arterial pressures in both groups. Subsequently, heart rate and systolic arterial pressure decreased until fWIT was reached. Pigs in the open-chest group displayed a more rapid transition to the HD phase after WLST, with peak heart rate and peak rate-pressure product occurring significantly earlier. Furthermore, the HD phase duration tended to be shorter and less intense (lower peak rate-pressure product) in the open-chest group than in the closed-chest group. Discussion: Progression from WLST to fWIT was more rapid, and the hemodynamic changes tended to be less pronounced in the open-chest group than in the closed-chest group. Our findings support clear differences between open- and closed-chest models of DCD. Therefore, recommendations for clinical DCD protocols based on findings in open-chest models must be interpreted with care. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The authors declared that they were an editorial board member of Frontiers at the time of submission. This had no impact on the peer review process and the final decision. (© 2024 Hubacher, Egle, Graf, Arnold, Segiser, Sanz, Casoni, Garcia Casalta, Nettelbeck, Mihalj, Siepe, Kadner and Longnus.)
Databáze:	MEDLINE
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