• Lise Tchouta, Daniel Drake, Mark Hoenerhoff, Alvaro Rojas-Pena, Jonathan Haft, Gabe Owens, Robert Bartlett, and University of Michigan Department of Surgery Extracorporeal Life Support Laboratory.
• Department of Surgery, Columbia University Medical Center, New York, NY; Extracorporeal Life Support Laboratory, Department of Surgery, University of Michigan Health Systems, Ann Arbor, Mich.
• J. Thorac. Cardiovasc. Surg. 2022 Jul 1; 164 (1): 128-138.

ObjectiveCross-circulation of plasma from a paracorporeal animal allows successful ex vivo heart perfusion (EVHP) for 3 days. Little is known about the feasibility of prolonged EVHP without a paracorporeal animal. These experiments evaluated plasma exchange (PX) that infuses fresh plasma, whereas an equal amount is removed to replace paracorporeal cross-circulation.MethodsTen hearts were procured from 8 to 10 kg piglets and maintained with EVHP. The EVHP circuit was primed with platelet- and leukocyte-reduced blood. Plasma obtained from stored porcine blood (4°C for ≤7 days) was infused and removed with a plasma separator at 1 mL/h/g cardiac tissue (n = 5) in the PX group. Controls (n = 5) used the same EVHP without PX. Antegrade aortic perfusion was adjusted to reach physiologic coronary flow of 0.7 to 1.2 mL/min/g, normothermia (37°C), and hemoglobin ≥8 g/dL. Viability was assessed by hemodynamic metrics, metabolic assays, and histopathology.ResultsAll PX hearts remained viable for 24 hours compared with only 1 control (P = .015). Coronary resistance was higher in the PX versus controls (1.06 ± 0.06 mm Hg/mL/min; 0.58 ± 0.02 mm Hg/mL/min [P < .05]). Lactate levels were lower in PX (2.8-4.2 mmol/L) versus controls (3.6-7.6 mmol/L) (P < .05). PX demonstrated a trend toward preservation of left ventricle systolic pressure (63.0 ± 10.9 mm Hg) versus controls (37 ± 22.0 mm Hg) (P > .05). In mixed effect models, oxygen consumption was higher with PX (P < .05). Histopathologic evaluation confirmed extensive myocardial degeneration and worse interstitial edema in controls.ConclusionsThese results demonstrate that EVHP can be successfully maintained for at least 24 hours using continuous PX. This eliminates the need for a paracorporeal animal and provides an important step toward clinical application.Copyright © 2020 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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