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Surgery. 2016 Oct;160(4):892-901. doi: 10.1016/j.surg.2016.06.039. Epub 2016 Aug 11.

Dual chamber stent prevents organ malperfusion in a model of donation after cardiac death.

Author information

1
Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA. Electronic address: tillmanbw@upmc.edu.
2
Industrial Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA.
3
Mechanical Engineering & Materials Science, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA.
4
Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
5
Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
6
Division of Transplantation Pathology, Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA.
7
McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA.
8
Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA.

Abstract

BACKGROUND:

The paradigm for donation after cardiac death subjects donor organs to ischemic injury. A dual-chamber organ perfusion stent would maintain organ perfusion without affecting natural cardiac death. A center lumen allows uninterrupted cardiac blood flow, while an external chamber delivers oxygenated blood to the visceral vessels.

METHODS:

A prototype organ perfusion stent was constructed from commercial stents. In a porcine model, the organ perfusion stent was deployed, followed by a simulated agonal period. Oxygenated blood perfused the external stent chamber. Organ perfusion was compared between controls (n = 3) and organ perfusion stent (n = 6). Finally, a custom, nitinol, dual chamber organ perfusion stent was fabricated using a retrievable "petal and stem" design.

RESULTS:

Endovascular organ perfusion stent deployment achieved visceral isolation without adverse impact on cardiac parameters. Visceral oxygen delivery was 4.8-fold greater compared with controls. During the agonal period, organs in organ perfusion stent-treated animals appeared well perfused in contrast with the malperfused controls. A custom nitinol and polyurethane organ perfusion stent was recaptured easily with simple sheath advancement.

CONCLUSION:

An organ perfusion stent maintained organ perfusion during the agonal phase in a porcine model of donation after cardiac death organ donation without adversely affecting cardiac function. Ultimately, the custom retrievable design of this study may help resolve the critical shortage of donor organs for transplant.

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PMID:
27524434
PMCID:
PMC5021586
DOI:
10.1016/j.surg.2016.06.039
[Indexed for MEDLINE]
Free PMC Article

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