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Somah – A Novel Modality for Subnormothermic Preservation of Donor Hearts

S. Lowalekar, H. Cao, X. Lu, P. Treanor, H. Thatte

Cardiac Surgery Division, VA Boston Healthcare System, Boston, MA
Surgery, Brigham and Women's Hospital, Boston, MA
Surgery, Harvard Medical School, Boston, MA

Meeting: 2013 American Transplant Congress

Abstract number: D1760

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Background- Donor hearts for transplant are stored in extreme hypothermic conditions to reduce ischemic damage. However, hypothermia-dependent cellular, biochemical, structural injuries are of concern. We hypothesized that hearts stored at sub-normothermia in a novel preservation solution ‘Somah' are less prone to hypothermic damage, efficiently meet ex vivo metabolic demands, and readily revivable on reperfusion.

Methods- Porcine donor hearts stored in Somah at 4, 13 or 21°C were weighed prior to and after 5-hrs with biopsies taken for histology and tissue high energy phosphates (HEP). Great vessels were cannulated and at end of 5-hrs, hearts perfused initially with Somah via aorta and then Somah-blood mixture. System temperature was raised to 37°C over 30-mins. Electroconversion and/or epinephrine used if required. Inflow (aortic) and outflow (caval) samples were taken at start and after 30-mins of perfusion for creatine kinase (CK), lactate and myocardial O2 consumption (MVO2). Epicardial 2D Echo was done using trans-esophageal echo probe at peak performance.

Results- Irrespective of storage temperature, after 5-hrs, heart weights were unaltered with normal histology; HEP levels were 55.7±5.1, 68.4±11.0 and 81.5 ± 19.8 nM/mg tissue and, upon reperfusion, outflow CK levels were 250.1±140.6, 45.7±18.9 and 36.6±11.3 U/L in 4, 13 and 21°C groups respectively. After 30-mins, lactate levels and MVO2 were unaltered in 4°C group but significantly decreased (p<0.01) and increased (p<0.01) respectively in both 13 and 21°C groups. Stimulatory interventions were inversely related to ex vivo storage temperature. Hearts in 13 and 21°C groups showed significantly high % fractional area change (%FAC; 39.2±8.6, 42.9±13.1) and ejection fraction (p<0.001) compared to 4°C group (%FAC=16.33±2.6). Peak cardiac output was 1.23±0.05, 1.93±0.36 and 2.1±0.3 L/min in 4, 13 and 21°C groups respectively.

Conclusion- This study demonstrated for first time that hearts can be stored in functionally viable state at sub-normothermic temperature in Somah. A rapid switch from anaerobic to aerobic metabolism, lesser creatine kinase release and fewer stimulatory interventions upon reperfusion of hearts stored at 13 and 21°C, suggest that sub-normothermic stored hearts are less prone to ischemia-reperfusion injury and more readily revivable than those stored at extreme hypothermia.

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To cite this abstract in AMA style:

Lowalekar S, Cao H, Lu X, Treanor P, Thatte H. Somah – A Novel Modality for Subnormothermic Preservation of Donor Hearts [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/somah-a-novel-modality-for-subnormothermic-preservation-of-donor-hearts/. Accessed January 27, 2021.

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