Hypothermic ex-vivo perfusion trialled for donor hearts

Cardiothoracic surgeons across Australia are embarking on a trial of ‘hypothermic ex-vivo perfusion’ to preserve donor hearts for a longer duration during transit.

Co-principal investigator, Professor David McGiffin of The Alfred, Melbourne, said the Swedish-developed XVIVO Perfusion device pumps perfusate through the heart muscle, cooling it to 8°c and keeping it supplied with oxygen.

The trial could potentially double the amount of time donor hearts remain viable for transplantation – increasing the current four hour standard to eight hours and allowing transport over greater distances, he said.

“If the trial demonstrates that the donor heart is better protected with ex-vivo perfusion as opposed to ice slush in a cooler, it could mean all donor hearts are transported using ex-vivo perfusion, no matter what distance,” Professor McGiffin said.

The Alfred’s director of cardiology and co-principal investigator, Professor David Kaye, said the patients involved in the trial had recovered well, which could be in part attributed to the nutrition and oxygen provided to the donor heart by the perfusion system.

“The best chance that a patient has of surviving heart transplantation is if they come out of the operating room with a well-functioning heart despite a very, very long ischemic time, and that’s what we think this system will deliver.”

Five sites across Australia and New Zealand are involved in the trial, with The Alfred the first to perform five transplants. Other sites include the Royal Children’s Hospital Melbourne, St Vincent’s Hospital Sydney, Fiona Stanley Hospital Perth and Auckland City Hospital, NZ.

Prehypertension accelerates brain ageing by six months

The adverse effects of elevated blood pressure on accelerated brain ageing are seen in early adulthood, according to a study from The Australian National University (ANU).

Researchers examined more than 2,000 brain scans of 686 healthy individuals aged 44 to 76 and compared grey matter scores for brain ageing with BP measurements across a 12-year period. They found that those with ‘prehypertension’ (135/85 mmHg) had a ‘brain age’ six months older than people with optimal BP.

Lead author, Professor Nicolas Cherbuin, Head of the ANU Centre for Research on Ageing, Health and Wellbeing, said the findings highlighted a particular concern for young people aged in their 20s and 30s because it takes time for the effects of increased blood pressure to impact the brain.

“By detecting the impact of increased blood pressure on the brain health of people in their 40s and older, we have to assume the effects of elevated blood pressure must build up over many years and could start in their 20s. This means that a young person’s brain is already vulnerable,” he said.

Cardiologist and co-author of the study, Professor Walter Abhayaratna, said the findings highlighted the importance of maintain optimal blood pressure through lifestyle and diet changes early in life.

“This thinking that one’s brain becomes unhealthy because of high blood pressure later in life is not completely true,” he said.

“It starts earlier and it starts in people who have normal blood pressure.”

The findings are published in Frontiers in Aging Neuroscience.

VTE prophylaxis death blamed on EMR failings;

Failure to give VTE prophylaxis to an elderly woman resulted in her death, which a Victorian coroner has blamed on poor functionality of a new Electronic Medical Record (EMR) system. A coronial investigation found that the elderly women had been admitted by Alfred Health for cancer radiotherapy treatment and had risk factors for VTE such as immobility. However, despite having VTE prophylaxis as part of her management plan from her medical team, this was not implemented. The investigation found this was because of poor communication between staff and a lack of VTE prophylaxis notifications on the new EMR system, which had just gone live. The coroner recommended that hospitals and regulators of digital health systems be reminded of the importance of having VTE risk assessments embedded in EMR systems and alerts for VTE prophylaxis provided in electronic medication charts.