1. Optimizing Donor Heart Outcome After Prolonged Storage With Endothelial Function Analysis and Continuous Perfusion 
Robert S. Poston, MD, Junyan Gu, MD, PhD, Deyanira Prastein, MD, Fred Gage, PhD, John W. Hoffman, BS, Michael Kwon, BS, Agnes Azimzadeh, PhD, Richard N. Pierson, MD, Bartley P. Griffith, MD 
The Annals of Thoracic Surgery 
Volume 78, Issue 4, Pages (October 2004)
DOI: /j.athoracsur

2. Fig 1
Portable perfusion pump. After baseline analysis in situ, hearts were excised and preserved by using cold storage for 8 or 24 hours or with continuous perfusion inside the sterile cassette pictured for 24 hours. After preservation, hearts were reperfused with blood at 37°C by using an isolated nonworking heart preparation to simulate transplantation.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )

3. Fig 2
Baseline thromboelastography (TEG) tracings were taken from the coronary sinus and aorta of each heart in the study. This representative example demonstrates a procoagulant coronary endothelium as evidenced by a marked increase in the coronary sinus TEG-α. The percentage transcoronary change (ie, coronary sinus − aorta/aorta × 100) in this example was (70.5°−65.1°)/65.1°×100 = 8.3%. After preservation and blood reperfusion by using an isolated, nonworking, heart model (ie, Langendorff), this heart recovered only 30.3% of baseline systolic pressure generation. (Ao = aorta; CS = coronary sinus.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )

4. Fig 3
After the preservation interval, hearts underwent blood reperfusion with an isolated nonworking heart model. During reperfusion, recovery of ventricular systolic function (dP/dt) was significantly greater in the continuous perfusion for 24 hours (CP×24h) group compared with the cold storage for 8 hours (CS×8h) group (p = 0.05 versus CP). However, systolic recovery was heterogeneous: 3 of 8 hearts in the CP×24h group developed primary graft dysfunction (ie, < 70% recovery of baseline dP/dt). Hearts preserved with cold static storage in Celsior for 24 hours (CS×24h) did not successfully recover heart function in this model (n = 2). (CP-A = hearts that showed good recovery; CP-B = hearts that showed poor recovery.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )

5. Fig 4
Viability analyses performed during CP that showed differences between the CP-A and CP-B groups in the following variables: coronary resistance calculated during perfusion, oxygen consumption during the first 4 hours of CP, protein release during the entire 24 hours of CP, and 4 hours of transcoronary vWF/Ag release determined by enzyme-linked immunosorbent assay. □ = good recovery (CP-A, n = 5); ■ = poor recovery (CP-B, n = 3). (Ao = aorta; CP = continuous perfusion; CP-A = hearts that showed good recovery; CP-B = hearts that showed poor recovery; CS = coronary sinus; MVo2 = maximal oxygen consumption; vWF = von Willebrand's factor.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )

6. Fig 5
Baseline assays of endothelial function that assessed the vasoreactivity (A) and coagulant phenotype (B) of the donor heart in situ. Contingency analyses, but not linear regression, showed a marked correlation between poor functional recovery and a baseline CFR less than 2.5 and percentage change TEG-α more than 5%. (CFR = coronary flow reserve; CP-A = hearts that showed good recovery; CP-B = hearts that showed poor recovery; dP/dT = systolic pressure generation; NS = not significant; TEG = thromboelastography.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )

7. Fig 6
Representative Western blot of vWF/Ag multimers in perfusate samples from the aorta (lanes 1 and 3) and coronary sinus (lanes 2 and 4) in hearts with good (CP-A: lanes 3 and 4) versus poor (CP-B: lanes 1 and 2) functional recovery. After 4 hours of CP, no aortic vWF was seen. Coronary sinus bands are stronger in hearts with poor postreperfusion recovery, suggesting an association of endothelial function with graft preservation. (Ao = aorta; CS = coronary sinus; vWF = von Willebrand's factor.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )