System for non-cardioplegic preservation of donor hearts for transplantation, comprises an equipment for the preservation of donor hearts, coaxial aortic cannula, perfusion management, organ holding bag and perfusion solution

摘要

System for non-cardioplegic preservation of donor hearts for transplantation, comprises an equipment for the preservation of donor hearts, where the donor heart is fastened to the coaxial aortic cannula (kA) and is enclosed by an organ holding bag (OHB), which is filled with perfusion solution; a coaxial aortic cannula, which allows the simultaneous perfusion of the donor heart and discharge of the left ventricle over only a single cannula; a perfusion management for the ischemia-free explantation of a donor heart; and a perfusion solution. System for non-cardioplegic preservation of donor hearts for transplantation, where the preservation, perfusion as well as the evaluation enables at the same time, comprises an equipment for the preservation of donor hearts, where the donor heart is fastened to the coaxial aortic cannula (kA) and is enclosed by an organ holding bag (OHB), which is filled with perfusion solution in such a manner that the donor heart floats in it, and the organ holding bag and the coaxial aortic cannula is connected over hose connectors with a membrane oxygenator (Oxy) for gas exchange and with a flexible chamber for temperature maintenance and adjustment of the pressure in the system, and with a filter unit (HF); a coaxial aortic cannula, which allows the simultaneous perfusion of the donor heart and discharge of the left ventricle over only a single cannula; a perfusion management for the ischemia-free explantation of a donor heart, which already intrathoracically allows a perfusion of the donor heart; and a perfusion solution for the donor heart from well-known components characterized by an additive of ketones in connection with glucose and insulin for the nutrition of the donor heart. Independent claims are included for: (1) an equipment for the non-cardioplegic myocardial preservation of donor hearts for transplantation; (2) a coaxial aortic cannula for the non-cardioplegic myocardial preservation of donor hearts for transplantation, comprising two lumen cannula simultaneously allowing the perfusion of the coronary artery of the heart and discharge of the left ventricle, in which the two-piece cannula is composed of a first cannula with a Y-shaped bypass of the hose connector aortic lumen, the hose connector left ventricular lumen and the aortic lumen, and from a second tubular structure running into first cannula with Y-shaped bypass of the hose connector left ventricular lumen to the aortic lumen, where the second tubular structure at the ventricle-sided end is rounded off, where it exhibits several openings brought into the wall; (3) a perfusion solution for the non-cardioplegic myocardial preservation of donor hearts for transplantation, comprising components for nutrition, for supply of oxygen, as electrolytes, for avoidance of inflammatory reactions and for prevention of edema formation, as colloids as well as for inhibition of coagulation, where the solution for nutrition comprises glucose, insulin, ketones as well as autologous, leucocyte-poor blood for oxygen supply; (4) perfusion management for the ischemia-free explantation of a donor heart, comprising mechanically fixing the donor organ to the coaxial aortic cannula and inserting a flexible organ holding bag made of plastic foil, which is filled with perfusion solution, where a hose connection for a drive pump is arranged at the lower edge of the organ holding bag, the drive pump pumps the perfusion solution through an oxygenator for gas exchange and through a flexible chamber for temperature maintenance, the flexible chamber (dK) provides the oxygenated perfusion solution with a pressure, which adjusts itself by autoregulation of the flexible chamber (dK) and through the coronary perfusion resistance of the heart, flowing the perfusion solution over hoses from the flexible chamber towards the aorta and the left chamber of the heart (coaxial aortic cannula) as well as filter unit, where in the normal operating condition, the flow into the left chamber of the heart is locked by a throttle clamp, so that the perfusion solution flows through the coaxial aortic cannula into the aorta and further through the coronary system of the donor heart and finally the coronary-venous blood in the sinus coronarius collects itself in the right atrium of the heart and since this atrium was locked by surgery, it is pumped by the heart to the right chamber of the heart and to the pulmonary artery, from where the perfusion solution is led into a dripping chamber, in which a pressure balance takes place with the pressure level in the organ holding bag; and (5) a method for the non-cardioplegic myocardial preservation of donor hearts for transplantation under use of the perfusion mechanism, with application of the perfusion management to ischemia-free explantation and the perfusion solution.