Metabolic characteristics of human hearts preserved for 12 hours by static storage, antegrade perfusion, or retrograde coronary sinus perfusion

Objective: Machine perfusion of donor hearts is a promising strategy to increase the donor pool. Antegrade perfusion is effective but can lead to aortic valve incompetence and nonnutrient flow. Experience with retrograde coronary sinus perfusion of donor hearts has been limited. We tested the hypothesis that retrograde perfusion could support myocardial metabolism over an extended donor ischemic interval. Methods: Human hearts from donors that were rejected or not offered for transplantation were preserved for 12 hours in University of Wisconsin Machine Perfusion Solution by: (1) static hypothermic storage; (2) hypothermic antegrade machine perfusion; or (3) hypothermic retrograde machine perfusion. Myocardial oxygen consumption (MVO2), and lactate accumulation were measured. Ventricular tissue was collected for proton and phosphorus 31 magnetic resonance spectroscopy (MRS) to evaluate the metabolic state of the myocardium. Myocardial water content was determined at the end of the experiment. Results: Stable perfusion parameters were maintained throughout the perfusion period with both perfusion techniques. Lactate/alanine ratios were lower in perfused hearts compared with static hearts (P < .001). Lactate accumulation (antegrade 2.0 +/- 0.7 mM, retrograde 1.7 +/- 0.1 mM) and MVO2 (antegrade 0.25 +/- 0.2 mL, retrograde 0.26 +/- 0.3 mL O-2/min/100 g) were similar in machine-perfused groups. High-energy phosphates were better preserved in both perfused groups (P < .05). Left ventricular myocardial water content was increased in retrograde perfused hearts (80.2 +/- 0.8%) compared with both antegrade perfused hearts (76.6 +/- 0.8%, P = .02) and static storage hearts (76.7 +/- 1%, P = .02). Conclusions: Machine perfusion by either the antegrade or the retrograde technique can support myocardial metabolism over long intervals. Machine perfusion seems promising for long-term preservation of human donor hearts.