*Purpose: Cardiac heart transplantation is the gold standard for treating end-stage heart failure; however, the list of patients waiting for heart transplants continues to increase. We have developed a portable hypothermic oxygenated machine perfusion device, the VP.S ENCORE^TM, to double the allowable preservation time. The purpose of this study was to test the efficacy of a VP.S. ENCORE^TM to preserve porcine hearts for extended time points and compare their cardiac viability and function to the hearts preserved using the standard of care (SCS).

*Methods: Isolated porcine hearts (N=22) were recovered under anesthesia and by inducing cardiac arrest through cardioplegia. Following cannulation, the experimental hearts were placed in the VP.S ENCORE™ and perfused at 4-8°C for either 4 hours (n=4), 8 hours (n=9) or were kept on ice for 4 hours ( n = 9). All hearts were assessed for edema. Hourly flow, pressure, temperature, and blood gas measurements were recorded. Following either preservation method, the hearts were placed in a Langendorff model for reperfusion and evaluated for cardiac function. Biopsy samples were taken before and at the end of each preservation method for histological and gene expression analyses.

*Results: Control hearts weight gain (%) was 2.17 ± 5.2, while perfused at 4 hours was -4.01 ± 4.7, and at 8 hours was -0.30 ± 6.6. Venous and arterial lactate concentrations were less than 2.5 mmol/L across all experiments. Perfused hearts at 4 hours and 8 hours had significantly increased contractility (p<0.05) than SCS as demonstrated by +dP/dT(mmHg) and peak developed left ventricular pressure (p<0.05). Gene expression analysis showed a significant reduction (p<0.005) of inflammation (IL-6, IL-8, TNFα) and cell death markers (p53,cTnI) in perfused hearts when compared to control hearts. Furthermore, a histological assessment confirmed greater myocardium damage in SCS hearts.

*Conclusions: Our results show that using the VP.S ENCORE™ cardiac preservation device enhances the viability and cardiac function of perfused porcine hearts thereby doubling the standard of care of 4 hours in static cold storage as assessed by perfusion parameters, gene expression assays, histopathology, and working heart model. Our findings imply that the VP.S ENCORE™ device may provide a new paradigm in the organ preservation field.

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