Impact of hypothermic machine perfusion on ischemia/reperfusion injury during heart transplantation

Organ transplantation is limited by ischemia/reperfusion injury inherent in the preservation period. This damage is greater in donors following circulatory death. The hearts of these donors are not used, for fear of primary graft dysfunction after transplantation. In this work, we studied the impact of hypothermic machine perfusion preservation on ischemia/reperfusion injury during cardiac transplantation. We have characterized the energy changes during ischemia, resulting in ATP depletion and lactate accumulation, and during reperfusion, knowing mitochondrial dysfunction. We demonstrated that the hypothermic machine perfusion reduces both ischemia during preservation and reperfusion injury and improves myocardial contractility during reperfusion. We also demonstrated that hypothermic perfusion allows functional recovery of donor grafts after circulatory arrest.La transplantation d’organes est limitée par les dégâts d’ischémie/reperfusion inhérents à la période de préservation. Ces dégâts sont plus importants chez les donneurs décédés d’un arrêt circulatoire. Les coeurs de ces donneurs ne sont pas utilisés, par peur d’une dysfonction du greffon. Dans ce travail, nous avons étudié l’impact de la préservation par perfusion hypotherme sur l’ischémie/reperfusion au cours de la transplantation cardiaque. Nous avons caractérisé les modifications énergétiques au cours de l’ischémie (déplétion en ATP et une accumulation de lactate), et lors de la reperfusion (dysfonction mitochondriale). Nous avons démontré que la perfusion hypotherme réduit les conséquences de l’ischémie pendant la préservation et les lésions de reperfusion et améliore la contractilité myocardique lors de la reperfusion. Nous avons aussi démontré que la perfusion hypotherme permet la récupération fonctionnelle de greffons de donneurs après arrêt circulatoire(MED - Sciences médicales) -- UCL, 201

Herzinsuffizienz : Therapiaschemata und Vasoaktive Substanzen

This chapter discuss medical and surgical treatments for both chronic and acute heart failur

Artificial Heart Support.

This chapter describes the history of mechanical circulatory, available paracorporeal or implantable systems, indications for mechanical circulatory support, patient selection and management, complications and future perspectives

Outcome of cardiac surgery patients with complicated intensive care unit stay.

Risk stratification has become an essential element in the practice of cardiac surgery. Several studies have identified preoperative risk factors for adverse outcome. However, outcome is mostly defined by 30-day mortality and morbidity. These data reflect poorly the benefit for the patient. Long-term survival, quality of life, and functional status should be included in a more global analysis of the outcome, particularly in patients with complicated ICU stay. By reviewing the recent data reported in the literature, we can identify a number of preoperative predictive factors for complicated ICU stay, including advanced age, chronic obstructive pulmonary disease, preoperative low ejection fraction, previous myocardial infarction, reoperation, renal failure, combined surgery (coronary artery bypass grafting plus valve surgery), low hematocrit, and neurologic impairment. Short- and long-term outcomes are dependent on the type of postoperative complication. Unfortunately, data regarding the long-term outcome in these situations are very scarce

[Malignant mitral valve prolapse: apropos of a case].

The authors report the case of a 67-year-old woman, with mitral valve prolapse, for more than 20 years. She recently complained of attacks of syncope and clinical ventricular tachycardia; ventricular fibrillation was induced during programmed stimulation. The patient seemed to be at high risk for sudden cardiac death, and was therefore treated with an automatic implantable defibrillator. The pathophysiology and risk factors of sudden cardiac death in mitral valve prolapse are discussed