Given the sensitive nature of heart baseline function, care must be taken to maintain the perfusion rig clean and with compatible components. For example, the correct PVC tubing must be used. Some tubing materials, such as silicone, can contribute to lower aortic flow and contractility, which may be due to loss of oxygen via the tubing. While there are isolated working rat heart perfusion circuits commercially available, most of these are primarily used for Langendorff perfusion only. Generally, functional measurements can be obtained in a Langendoff perfusion model via the insertion of a balloon catheter into the left ventricle to obtain left ventricular diastolic pressure (LVDP) measurements. However, the ability to measure raw aortic flow measurements and cardiac output in a Langendoff perfusion system is not possible. A main advantage of the IWRH protocol is the ability to obtain aortic flow and cardiac output functional measurements without the need for additional interventions of the heart (i.e., balloon catheter). There are commercial options for a working rat heart perfusion system and although these can be customizable for individual study requirements, these systems can be costly.
There are critical steps in the protocol to ensure optimal baseline function of the rodent heart during perfusion. Preparation of KHB buffer stock solutions should be no older than 4 weeks. The perfusion circuit must be free of any air bubbles when priming. Care must be taken when cannulating the left atrial appendage. Excessive handling of the tissue can increase the risk of tearing and can also add to functional irritability of the heart.
The IWRH perfusion circuit performance quality can generally be determined by the baseline readings obtained in hearts (AF > 30 mL/min, CF ~20 mL/min). Further quality control testing in a CSS model can be performed by arresting and storing the heart in Celsior preservation solution supplemented with 1 µmol/L zoniporide plus 0.1 mg/mL glyceryl trinitrate. Hearts arrested with Celsior supplemented with glyceryl trinitrate plus zoniporide guarantees immediate Langendorff reperfusion recovery and a final functional recovery between 40-60% after 6 h cold storage. If in doubt as to whether the rig is performing well, this quality control supplementation is useful to test.
The methods for using rodent hearts procured via donation after circulatory death have been previously described10,11. Briefly, rats are anesthetized, the carotid artery cannulated, and pressure readings obtained. Heparin (500 IU) is injected via the carotid artery cannula. The trachea is ligated to initiate withdrawal of life support. Once the required warm ischemic time is reached, the heart can be excised and cannulated onto the perfusion circuit. For administration of preservation solution into the DCD heart, 60 mL of preservation solution is flushed through the aorta (~20 mL/min) via the pressure line on the circuit. The pulmonary vessels are tied, the lungs are dissected, the left cannula is inserted, and then 40 mL of preservation solution is flushed via the pressure line. The heart is then perfused as per the protocol above. Functional recovery is taken as a raw value of functional hemodynamics, and statistical analysis is performed by comparing the values to those hearts that were sham-operated (no DCD, however, flushed on the rig).
The methods for using rodent hearts procured after brain death have been previously described12. Briefly, animals are anesthetized, intubated, and ventilated, with hemodynamic monitoring as per DCD rodent protocol. A burr hole is performed in the temporoparietal skull, and a 3F embolectomy catheter is placed sub-durally. Sham controls have burr holes but no catheter insertion. The balloon is inflated with 0.3 mL water over 2 min and kept inflated for 1 h. After 1 h of hemodynamic observation, hearts are explanted and placed onto the isolated working heart perfusion circuit, baseline measurements are recorded, cardioplegia is administered, and hearts are cold stored as described above.
The main limitation of using the IWRH perfusion circuit is the inability to use a blood-based perfusion buffer to circulate through the system. It would be impossible to source enough rodent blood to add to the perfusate; therefore, blood-based perfusion is not feasible. Alternative models, such as rodent heterotopic heart transplant or large animal orthotopic heart transplant studies, would likely need to be performed to test the impact of blood-based perfusion. However, these alternative methods require expertise in microsurgical skills and/or large animal surgical facilities and experienced anesthetists, perfusionists, and cardiothoracic surgeons.