METHOD OF CONDITIONING A DONOR HEART

Abstract

In medicine, and more specifically, in cardiac surgery and perfusiology. In order to improve heart transplantation results by optimizing the conditioning of a heart, the method of conditioning a donor heart comprises a set of measures including an administration of a blood cardioplegic solution, an ultrafiltration and Levosimendan. For cardioplegia in the body of the donor, a normothermic solution consisting of donor blood and a crystalloid solution at the ratio of 5:1 (potassium chloride 4%, magnesium sulfate 25%, lidocaine 2%, sodium hydrocarbonate, and mannitol 15%) is used. To protect the myocardium and enhance its blood circulation, a single dose of Levosimendan (45 g/kg) is injected into the perfusate. To remove inflammatory mediators, an excessive amount of fluid, and to correct the electrolyte composition and the hematocrit, the perfusate is ultrafiltered. Prior to transplantation to a recipient, the blood cardioplegic solution is administrated to wean the donor heart off the OCS device.

Claims

1. A method of conditioning a donor heart during transportation by using an OCS, comprising: administering a blood cardioplegic solution, performing an ultrafiltration, and administering Levosimendan, wherein the method comprises: introducing Levosimendan into a perfusate, removing inflammatory mediators, eliminating an excess of fluid, achieving a correction of electrolyte composition and of hematocrit by ultrafiltration of the perfusate, and prior to transplantation to a recipient of the heart to be weaned off the OCS device, administering the blood cardioplegic solution.

Description

[0006] The objective of the present invention is to improve heart transplantation results by optimizing the conditioning of a heart by the described method. The method of conditioning a donor heart comprises a set of measures including an administration of a blood cardioplegic solution, an ultrafiltration and Levosimendan. For cardioplegia in the body of the donor, a normothermic solution consisting of donor blood and a crystalloid solution at the ratio of 5:1 (potassium chloride 4%, magnesium sulfate 25%, lidocaine 2%, sodium hydrocarbonate, and mannitol 15%) is used. To protect the myocardium and enhance its blood circulation, a single dose of Levosimendan (45 g/kg) is injected into the perfusate. To remove inflammatory mediators, an excessive amount of fluid, and to correct the electrolyte composition and the hematocrit, the perfusate is ultrafiltered. Prior to transplantation to a recipient, the blood cardioplegic solution is administrated to wean the donor heart off the OCS device.

[0007] The advantage of using a blood solution for cardioplegia is the high concentration of potassium ions in the solution, which facilitates faster stopping of the heart with the duration of safe anoxia of the myocardium of 20 minutes. The cardioplegic effect is enhanced by lidocaine contained in the solution, which stabilizes the myocardium, causing a delay in the reactivation of the fast sodium channels of the cardiomyocyte membrane. In addition, the advantages of blood cardioplegia are associated with high oxygen and buffer capacity of the red blood cells; the presence of energy and plastic substrates to sustain myocardial metabolism; adequate colloid osmotic pressure to prevent the development of intracellular edema; the presence of natural antioxidants to reduce the risk of reperfusion injury; and a reduction in total hemodilution during surgery, which is especially important in case of prolonged myocardial ischemia and its reduced functional capabilities.

[0008] The proposed method has undeniable advantages in comparison with the standard method (Custodiol) for protecting the myocardium.

TABLE-US-00001 TABLE 1 Composition of blood cardioplegia 600 ml: KCl 4% 30 ml MgS0.sub.4 25% 10 ml Lidocaine 2% 2 ml NaHCO.sub.3 13 ml Mannitol 15% 6.5 ml Blood up to a volume of 600 ml