{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:46:41Z","timestamp":1760060801719,"version":"build-2065373602"},"reference-count":22,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T00:00:00Z","timestamp":1758153600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Chonnam National University Hospital Biomedical Research Institute","award":["BCRI24036","RS-2023-00238181"],"award-info":[{"award-number":["BCRI24036","RS-2023-00238181"]}]},{"DOI":"10.13039\/501100003662","name":"Korea Evaluation Institute of Industrial Technology (KEIT)","doi-asserted-by":"publisher","award":["BCRI24036","RS-2023-00238181"],"award-info":[{"award-number":["BCRI24036","RS-2023-00238181"]}],"id":[{"id":"10.13039\/501100003662","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Normothermic ex situ heart preservation maintains donor heart viability by sustaining physiological conditions and reducing ischemic damage. However, the ideal perfusion pressure remains uncertain. This study aims to identify the optimal perfusion pressure to enhance graft preservation in rat heart transplantation. Materials and Methods: We utilized 20 male Sprague-Dawley rats (400\u2013500 g). Donor hearts underwent normothermic preservation for 2 h using a Langendorff apparatus primed with 12 mL of solution at a consistent 3 mL\/min flow. After preservation, hearts were transplanted heterotopically into the recipient\u2019s abdomen. We defined successful preservation by observing a QRS complex in electrocardiographic monitoring for 3 h post-transplantation. Histological assessments for myocardial integrity occurred after 4 h of reperfusion. We analyzed statistical differences between successful and unsuccessful preservation groups. Results: Electrocardiograms indicated preservation failure in 8 of the 20 donor hearts due to the absence of a QRS complex. We observed no significant differences in ischemic duration between groups. At 120 min, although serum lactate and potassium concentrations increased in the unsuccessful group, the differences were not statistically significant. Higher initial perfusion pressures (&gt;65 mmHg) at a constant flow rate resulted in elevated lactate and potassium concentrations post-preservation, indicating suboptimal outcomes. Histologically, hematoxylin and eosin staining showed better myocardial preservation in successful hearts, while TUNEL assays demonstrated increased apoptosis in unsuccessful hearts. All hearts increased in weight after preservation, but significant increases occurred only in unsuccessful cases. Conclusions: Higher initial perfusion pressures (&gt;65 mmHg) negatively affect heart preservation outcomes, resulting in elevated serum lactate and potassium levels, increased heart weight, and greater histological damage. Maintaining optimal perfusion pressures is essential to preserve myocardial integrity and functional viability during normothermic ex situ heart preservation.<\/jats:p>","DOI":"10.3390\/medicina61091696","type":"journal-article","created":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T14:45:46Z","timestamp":1758206746000},"page":"1696","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Optimal Perfusion Pressure Enhances Donor Heart Preservation During Normothermic Ex Situ Perfusion in a Rat Transplantation Model"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2262-2882","authenticated-orcid":false,"given":"Do Wan","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital and Medical School, Gwangju 61469, Republic of Korea"},{"name":"Extracorporeal Cardiopulmonary Innovation, Technology, and Education (EXCITE) Research Group, Chonnam National University Hospital, Gwangju 61469, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"YeongEun","family":"Jo","sequence":"additional","affiliation":[{"name":"Extracorporeal Cardiopulmonary Innovation, Technology, and Education (EXCITE) Research Group, Chonnam National University Hospital, Gwangju 61469, Republic of Korea"},{"name":"Biomedical Research Institute, Chonnam National University Hospital, Gwangju 61469, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiae","family":"Seong","sequence":"additional","affiliation":[{"name":"Extracorporeal Cardiopulmonary Innovation, Technology, and Education (EXCITE) Research Group, Chonnam National University Hospital, Gwangju 61469, Republic of Korea"},{"name":"Biomedical Research Institute, Chonnam National University Hospital, Gwangju 61469, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5324-6045","authenticated-orcid":false,"given":"Reverien","family":"Habimana","sequence":"additional","affiliation":[{"name":"Extracorporeal Cardiopulmonary Innovation, Technology, and Education (EXCITE) Research Group, Chonnam National University Hospital, Gwangju 61469, Republic of Korea"},{"name":"Department of Medical Science, Chonnam National University Graduate School, Gwangju 61469, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2458-8529","authenticated-orcid":false,"given":"Hwa Jin","family":"Cho","sequence":"additional","affiliation":[{"name":"Extracorporeal Cardiopulmonary Innovation, Technology, and Education (EXCITE) Research Group, Chonnam National University Hospital, Gwangju 61469, Republic of Korea"},{"name":"Department of Pediatrics, Chonnam National University Children\u2019s Hospital, Chonnam National University Medical School, Gwangju 61469, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5533-3270","authenticated-orcid":false,"given":"Mukhammad","family":"Kayumov","sequence":"additional","affiliation":[{"name":"Extracorporeal Cardiopulmonary Innovation, Technology, and Education (EXCITE) Research Group, Chonnam National University Hospital, Gwangju 61469, Republic of Korea"},{"name":"Division of Transplant Surgery, Department of Surgery, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA 02115, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2249-0667","authenticated-orcid":false,"given":"Inseok","family":"Jeong","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital and Medical School, Gwangju 61469, Republic of Korea"},{"name":"Extracorporeal Cardiopulmonary Innovation, Technology, and Education (EXCITE) Research Group, Chonnam National University Hospital, Gwangju 61469, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Ughetto, A., Roubille, F., Molina, A., Battistella, P., Gaudard, P., Demaria, R., Guihaire, J., Lacampagne, A., and Delmas, C. (2023). Heart graft preservation technics and limits: An update and perspectives. Front. Cardiovasc. Med., 10.","DOI":"10.3389\/fcvm.2023.1248606"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Cameli, M., Pastore, M.C., Campora, A., Lisi, M., and Mandoli, G.E. (2022). Donor shortage in heart transplantation: How can we overcome this challenge?. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.1001002"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Hess, N.R., Ziegler, L.A., and Kaczorowski, D.J. (2022). Heart Donation and Preservation: Historical Perspectives, Current Technologies, and Future Directions. J. Clin. Med., 11.","DOI":"10.3390\/jcm11195762"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1111\/tri.12361","article-title":"Normothermic donor heart perfusion: Current clinical experience and the future","volume":"28","author":"Messer","year":"2015","journal-title":"Transpl. Int."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Li, J., Xue, C., Ling, X., Xie, Y., Pavan, D., Chen, H., Peng, Q., Lin, S., Li, K., and Zheng, S. (2021). A Novel Rat Model of Cardiac Donation After Circulatory Death Combined with Normothermic ex situ Heart Perfusion. Front. Cardiovasc. Med., 8.","DOI":"10.3389\/fcvm.2021.639701"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1016\/j.jss.2024.12.050","article-title":"A Comparative Study Between Cold Static Storage and Normothermic Ex-Situ Donor Heart Preservation in a Rat Model of Heterotopic Heart Transplantation","volume":"306","author":"Kayumov","year":"2025","journal-title":"J. Surg. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1097\/MAT.0000000000000382","article-title":"Achieving 12 Hour Normothermic Ex Situ Heart Perfusion: An Experience of 40 Porcine Hearts","volume":"62","author":"Trahanas","year":"2016","journal-title":"ASAIO J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1016\/j.transproceed.2012.08.022","article-title":"Low-flow perfusion preservation versus static preservation for isolated rat heart: Effects on recovery of myocardial function","volume":"45","author":"Li","year":"2013","journal-title":"Transplant. Proc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1097\/00002480-200007000-00004","article-title":"Ex vivo cardiac allograft preservation by continuous perfusion techniques","volume":"46","author":"Smulowitz","year":"2000","journal-title":"ASAIO J."},{"key":"ref_10","first-page":"e64954","article-title":"Rat model of normothermic ex-situ perfused heterotopic heart transplantation","volume":"194","author":"Kayumov","year":"2023","journal-title":"J. Vis. Exp."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1097\/MAT.0000000000000630","article-title":"Determination of Optimal Coronary Flow for the Preservation of \u201cDonation after Circulatory Death\u201d in Murine Heart Model","volume":"64","author":"Quader","year":"2018","journal-title":"ASAIO J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e41610","DOI":"10.1016\/j.heliyon.2024.e41610","article-title":"Physiological arterial pressure improves renal performance during normothermic machine perfusion in a porcine kidney DCD model","volume":"11","author":"Fang","year":"2025","journal-title":"Heliyon"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e14094","DOI":"10.1111\/eci.14094","article-title":"Association between lactate\/albumin ratio and prognosis in patients with acute myocardial infarction","volume":"54","author":"Chen","year":"2024","journal-title":"Eur. J. Clin. Investig."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1177\/2047487318780466","article-title":"Serum potassium levels and mortality of patients with acute myocardial infarction: A systematic review and meta-analysis of cohort studies","volume":"26","author":"Xi","year":"2019","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1007\/s10047-024-01447-x","article-title":"Introduction of ex vivo perfusion of extended-criteria donor hearts in a single center in Asia","volume":"28","author":"Lee","year":"2024","journal-title":"J. Artif. Organs"},{"key":"ref_16","first-page":"e61126","article-title":"Effects of Serum Potassium on Mortality in Patients With ST-Elevation Myocardial Infarction","volume":"16","author":"Jensen","year":"2024","journal-title":"Cureus"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1159\/000327033","article-title":"Organ Preservation: Current Concepts and New Strategies for the Next Decade","volume":"38","author":"Guibert","year":"2011","journal-title":"Transfus. Med. Hemother"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Arnold, M., Segiser, A., Graf, S., M\u00e9ndez-Carmona, N., Sanz, M.N., Wyss, R.K., Kalbermatter, N., Keller, N., Carrel, T., and Longnus, S. (2021). Pre-ischemic Lactate Levels Affect Post-ischemic Recovery in an Isolated Rat Heart Model of Donation After Circulatory Death (DCD). Front. Cardiovasc. Med., 8.","DOI":"10.3389\/fcvm.2021.669205"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1161\/CIRCHEARTFAILURE.112.968388","article-title":"Electrocardiographic characteristics of potential organ donors and associations with cardiac allograft use","volume":"5","author":"Khush","year":"2012","journal-title":"Circ. Heart Fail."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.1016\/j.transproceed.2010.02.073","article-title":"Importance of organ preservation solution composition in reducing myocardial edema during machine perfusion for heart transplantation","volume":"42","author":"Cobert","year":"2010","journal-title":"Transplant. Proc."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"100074","DOI":"10.1016\/j.jhlto.2024.100074","article-title":"Dialysis preserves heart function during ex situ heart perfusion","volume":"4","author":"Yu","year":"2024","journal-title":"JHLT Open"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1016\/j.healun.2023.12.002","article-title":"Metabolomic profiling during ex situ normothermic perfusion before heart transplantation defines patterns of substrate utilization and correlates with markers of allograft injury","volume":"43","author":"Truby","year":"2024","journal-title":"J. Heart Lung Transplant."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/9\/1696\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:48:15Z","timestamp":1760035695000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/9\/1696"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,18]]},"references-count":22,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["medicina61091696"],"URL":"https:\/\/doi.org\/10.3390\/medicina61091696","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2025,9,18]]}}}