Coronary Arteries Investigation in Normothermic Ex Situ Heart Perfusion Machine

The ex situ heart perfusion technique is noninferior to the standard of care static cold preservation in heart transplantation. It has enabled the expansion of donor criteria and provides reconditioning or treatment as well as diagnostic approaches. Angiography during ex situ heart perfusion is anecdotal but may be useful to evaluating anatomy and somehow coronary physiology on the beating donor heart. The aim of this study was to assess the efficacy and safety of coronary investigation of the beating heart during normothermic ex situ heart perfusion using our institution's unique system. Five domestic adult pigs (90-95 kg, 1-1.5 years of age) were included in the study. After cardiectomy, the pig hearts were connected to the ex situ device, and ex situ angiography and intravascular ultrasound were performed. Cineangiographic images were obtained in different orientations by rotating the C-arm around the heart to find the best angiographic projections for the coronary arteries to be visualized. The results of our study support ex situ coronary arteries evaluation during the normothermic ex situ heart perfusion as a reliable, safe procedure that can be successfully carried out when necessary. The intravascular ultrasound can be used as an adjunctive technology for creating a full picture of the coronary arteries' anatomy.