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Prevention of ischemic myocardial contracture through hemodynamically controlled DCD

Wahlquist, Ylva LU ; Soltesz, Kristian LU orcid ; Liao, Qiuming LU ; Liu, Xiaofei ; Pigot, Harry LU orcid ; Sjöberg, Trygve LU and Steen, Stig LU (2021) In Cardiovascular Engineering and Technology 12(5). p.485-493
Abstract
Purpose—Ischemic myocardial contracture (IMC) or ‘‘stoneheart’’ is a condition with rapid onset following circulatory death. It inhibits transplantability of hearts donated uponcirculatory death (DCD). We investigate the effectiveness of hemodynamic normalization upon withdrawal of life-sustaining therapy (WLST) in a large-animal controlled DCD model, with the hypothesis that reduction in cardiac work delays the onset of IMC. Methods—A large-animal study was conducted comprising of a control group (n = 6) receiving no therapy upon WLST, and a test group (n = 6) subjected to a protocol for fully automated computer-controlled hemodynamic drug administration. Onset of IMC within 1 h following circulatory death defined the primary end-point.... (More)
Purpose—Ischemic myocardial contracture (IMC) or ‘‘stoneheart’’ is a condition with rapid onset following circulatory death. It inhibits transplantability of hearts donated uponcirculatory death (DCD). We investigate the effectiveness of hemodynamic normalization upon withdrawal of life-sustaining therapy (WLST) in a large-animal controlled DCD model, with the hypothesis that reduction in cardiac work delays the onset of IMC. Methods—A large-animal study was conducted comprising of a control group (n = 6) receiving no therapy upon WLST, and a test group (n = 6) subjected to a protocol for fully automated computer-controlled hemodynamic drug administration. Onset of IMC within 1 h following circulatory death defined the primary end-point. Cardiac work estimates based on pressure-volume loop concepts were developed and used to provide insight into the effectiveness of the proposed computer-controlled therapy. Results—No test group individual developed IMC within 1 h, whereas all control group individuals did (4/6 within30 min). Conclusion—Automatic dosing of hemodynamic drugs in the controlled DCD context has the potential to prevent onset of IMC up to 1 h, enabling ethical and medically safe organ procurement. This has the potential to increase the use of DCD heart transplantation, which has been widely recognized as a means of meeting the growing demand for donor hearts. (Less)
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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Cardiovascular Engineering and Technology
volume
12
issue
5
pages
485 - 493
publisher
Springer
external identifiers
  • scopus:85105310577
  • pmid:33928495
ISSN
1869-408X
DOI
10.1007/s13239-021-00537-8
project
Hemodynamic Stabilization
language
English
LU publication?
yes
id
f8213bf8-89f8-427e-9f28-d981417111b3
date added to LUP
2021-03-31 09:12:09
date last changed
2024-05-04 05:05:20
@article{f8213bf8-89f8-427e-9f28-d981417111b3,
  abstract     = {{Purpose—Ischemic myocardial contracture (IMC) or ‘‘stoneheart’’ is a condition with rapid onset following circulatory death. It inhibits transplantability of hearts donated uponcirculatory death (DCD). We investigate the effectiveness of hemodynamic normalization upon withdrawal of life-sustaining therapy (WLST) in a large-animal controlled DCD model, with the hypothesis that reduction in cardiac work delays the onset of IMC. Methods—A large-animal study was conducted comprising of a control group (n = 6) receiving no therapy upon WLST, and a test group (n = 6) subjected to a protocol for fully automated computer-controlled hemodynamic drug administration. Onset of IMC within 1 h following circulatory death defined the primary end-point. Cardiac work estimates based on pressure-volume loop concepts were developed and used to provide insight into the effectiveness of the proposed computer-controlled therapy. Results—No test group individual developed IMC within 1 h, whereas all control group individuals did (4/6 within30 min). Conclusion—Automatic dosing of hemodynamic drugs in the controlled DCD context has the potential to prevent onset of IMC up to 1 h, enabling ethical and medically safe organ procurement. This has the potential to increase the use of DCD heart transplantation, which has been widely recognized as a means of meeting the growing demand for donor hearts.}},
  author       = {{Wahlquist, Ylva and Soltesz, Kristian and Liao, Qiuming and Liu, Xiaofei and Pigot, Harry and Sjöberg, Trygve and Steen, Stig}},
  issn         = {{1869-408X}},
  language     = {{eng}},
  number       = {{5}},
  pages        = {{485--493}},
  publisher    = {{Springer}},
  series       = {{Cardiovascular Engineering and Technology}},
  title        = {{Prevention of ischemic myocardial contracture through hemodynamically controlled DCD}},
  url          = {{https://lup.lub.lu.se/search/files/96270933/soltesz21b.pdf}},
  doi          = {{10.1007/s13239-021-00537-8}},
  volume       = {{12}},
  year         = {{2021}},
}