Possible Pathophysiology and Management of Donor LVSD Following Brain Death
Nearly one-quarter of nonacceptance of potential donor hearts is due to left ventricular systolic dysfunction (LVSD). An initial catecholamine surge causing a sympathetic storm is followed by progressive loss of sympathetic tone and catecholamine depletion, which can lead to decreases in systemic vascular resistance (SVR), coronary perfusion, myocardial contractility, and more, producing LVSD (steps 1 to 4). Subsequent appropriate donor management may be key to LVSD reversal and possible use of the donor heart for transplantation. LV = left ventricular; LVEF = left ventricular ejection fraction; TTE = transthoracic echocardiogram.