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ObjectivesCold crystalloid cardioplegia for donor heart harvesting and cold ischemic storage conditions during the transportation is the standard of care during heart transplantation procedure. Organ care system (OCS) was introduced for more prolonged and reliable ex vivo organ management. This study evaluated the two different techniques used for myocardial preservation during the procurement and transportation of the heart using the OCS.MethodsWe performed prospective analysis of 43 patients with heart failure undergoing heart transplantation and using the OCS for donor organ transport. Donor hearts were arrested using blood cardioplegia and conditioning (n = 30) or standard Custodiol (SC) solution ( n = 13). Perfusion and cardiac function parameters were continuously monitored while the donor hearts were perfused in the OCS. Impact of preservation techniques on biochemical parameters and clinical outcomes were evaluated.ResultsAll donor hearts had stable perfusion and lactate characteristics in the OCS, with similar measures between the two groups at the beginning of the ex vivo perfusion. Ex vivo heart perfusion mean ending concentration of Interleukin (IL)‐6 and IL‐8 was significantly lower in the blood cardioplegia group compared to the standard care group. Clinical outcomes were comparable between the two groups of patients.ConclusionsThe use of blood cardioplegia and conditioning could be a safe method for myocardial protection in distant procurement and preservation of donor hearts in the OCS.

Background Organ Care System (OCS) minimizes the cold ischemic time and allows for optimization of logistics and meticulous recipient preparation. Impact of normothermic ex-vivo preservation using OCS compared with cold storage (CS) for prolonged heart preservation especially beneficial for high-risk recipients bridged to transplantation with Mechanical Circulatory Support (MCS). Methods Between 2012 and 2018, we performed a retrospective single-center review of prospectively collected data. All patients who underwent heart transplantation with MCS using the OCS Heart (n = 25) versus standard cold storage (n = 10) were included in this study. Results During this period, 353 patients were implanted with left ventricular assisted device (LVAD) and 35 (10%) were bridged to heart transplantation. There was no significant difference in donor and recipient characteristics and risk factors. The Index for Mortality Prediction after Cardiac Transplantation (IMPACT) score was a trend towards higher estimated risk of death at 1y in the OCS group (14.2 vs. 10.8% p = 0.083). Mean total ischemic time during preservation was statistically significantly longer in CS vs OCS group (210 (23) Vs 74.6 (13) min p = 0.001). Median ex vivo normothermic heart perfusion time in OCS was 348.4(132; 955) min. There was significant difference in total out of body time between OCS group 423(67) Vs CS group 210(23) min p = 0.002). All patients were alive on the 30th days post implant in CS groups and 96% in OCS group (p = 0.5). Conclusion Normothermic ex-vivo preservation of the allograft during transportation with the organ care system might be beneficial for long-time out of body organ preservation in comparison of cold storage especially for recipients on mechanical circulatory support.

Background ECMO support is associated with the development of a systemic hyper‐inflammatory response, which may become quite significant and extreme in some cases. We hypothesize that Cytosorb or Jafron therapy may benefit patients on V‐A ECMO in terms of levels of inflammatory markers such as IL‐6, complications, and overall outcomes. Methods We conducted a retrospective study of prospectively collected data in a single tertiary care center between January 2021 and April 2022. At the time of the analysis of this article, 20 patients on V‐A ECMO had cytokine adsorption while on ECMO support: Cytosorb group (n = 10), Jafron group (n = 10). In 10 ECMO‐supported patients cytokine adsorption was not used, this group served as a control group, which may be quite significant in some cases. Evaluation of the level of inflammatory markers (IL‐1, 6, 8; CRP, Leukocyte, Lactate, PCT, NT‐proBNP, TNF‐α) was performed. Results There was statistically significant longer CPB time, aortic cross‐clamp time and ICU stay in cytokine adsorption groups than in the control group, but there were no differences between subgroups with different types of haemoadsorption used. Moreover, in the control group mortality rate was higher than in the cytokine adsorption groups (60% vs. 20%, p = 0.02). All patients had an elevation of inflammatory markers in the perioperative and immediate postoperative periods. After 72 h of intensive care, blood inflammation markers had a tendency to decline. Conclusion At the time of writing, hemadsorption in patients requiring V‐A ECMO support represents a good therapeutic effect. This effect is permanent for the whole period of extracorporeal cytokine hemadsorption application for both CytoSorb and Jafron HA330 devices.

Background and Aims Cardiac surgery is maintained by various complications. Major contribution associated with cardiopulmonary bypass (CBP). Cardiac surgery with CPB provokes activation of the cascade mechanism of inflammation with releasing of cytokines and a systemic inflammatory response syndrome (SIRS). Activation of the contact system due to exposure of artificial surface of the bypass circuit to blood cells, endotoxemia, ischemia and reperfusion injury and surgical trauma are all potential triggers of inflammation following CPB. This inflammatory reaction may leads to the development of postoperative complications, including vasoplegia, cytokine storm, myocardial dysfunction, respiratory failure, acute kidney injury, coagulopathy bleeding, and multiple organ dysfunction syndrome (MODS).  A number of different strategies, including new pharmacologic agents, CPB circuits and components, and surgical techniques, have been employed during the last few years in attempts to minimize the impact of SIRS on the outcome of cardiac surgical patients. However, the complex pathophysiology of this problem has not allowed, until now, the use of a single strategy.  The aim of our study is assessment of early application of extracorporeal cytokine adsorbers to the inflammation system during open-heart surgery with prolonged cardiopulmonary bypass. Method This prospective randomized single-center controlled trial observed patients, who were assigned a planned open cardiac surgery with a duration of cardiopulmonary bypass (CPB) more than 120 minutes between January 2021 to January 2023. Patients were randomized into three groups: CytoSorb -300 group, HA 330 group and the control group. A simple 1:1:1 randomization method was applied. Cytokine hemadsorption was conducted intraoperatively. Two types of cytokine cartridges were applied CytoSorb 300 (Cytosorbents Europe GmbH). НА330 (Jafron Biomedical Co., Ltd. China). The inclusion criteria: age ≥18 years, informed consent to participate in the study, CPB more than 120 min. The exclusion criteria: Age less than 18 years; refusal to participate in the study. Results The data of the HA 330 (n = 22) and CytoSorb300 (n = 22) groups were compared with the data of the control group (n = 22). The primary results and details of the work are given in Tables 1-3. Conclusion Intraoperative hemadsorption may be beneficial for patients who underwent open-heart surgery with prolonged CPB. The early hemadsorption has positive impact to postoperative period after cardiac surgery and may reduce requirement of renal replacement therapy.