Current approaches in retrieval and heart preservation

Abstract

Fifty years after the first successful heart transplantation, despite multiple advances in the treatment of advanced acute and chronic heart failure, there is still no equivalent to heart transplantation as a long-term treatment for end-stage heart failure. Transplantation is, however, limited by the scarcity and quality of heart allografts. Donors are nowadays significantly older, particularly in European countries, and traumatic head injury as the cause of death has been replaced by intracerebral hemorrhage or hypoxic brain damage in the majority of cases. In addition, many donors have undergone extensive resuscitation efforts. Recipient characteristics have progressively changed too within the last couple of decades; recipients are older, often with comorbidities and nearly half of them are bridged to transplant with a wide variety of mechanical circulatory support devices. These developments have resulted in heart transplant surgery becoming significantly more challenging with longer more complex surgery and increased ischemia times for organs that were previously considered to be borderline or non-transplantable in many cases. To address this, several options have been explored within the last years and as a result, novel strategies have been developed and tested in order to optimize graft preservation and potentially increase the donor pool. The two notable developments are the ability to procure hearts from donors after circulatory death and the advent of ex-vivo perfusion of hearts. This technology has made the transplantation of extended criteria organs, including those from circulatory determined death (DCD) donors possible, and allow for out of body time of more than 12 hours in heart transplantation. In this review, we set out the basis of the current practices in organ procurement, and the opportunities for the future as demands for organ transplantation continue to increase.

Outcomes of heart transplantation in patients bridged with Impella 5.0: Comparison with native chest transplanted patients without preoperative mechanical circulatory support

“…end-stage heart failure, the lack of donors and a worsening comorbidity profile has turned time on the waiting list into a via crucis, 3 especially for those patients requiring immediate treatment.…”

Is the Organ Care System (OCS) Still the First Choice With Emerging New Strategies for Donation After Circulatory Death (DCD) in Heart Transplant?

“…It allows continuous monitoring of aortic pressure, lactate level, and coronary blood flow of the graft [10]. Continuous measurement of lactate levels from the arterial and venous side of the graft in the OCS allows for assessing the adequacy of coronary blood flow [11] (Figure 1). The aorta is connected to the aortic line, the pulmonary artery is connected to the pulmonary artery line (PA line), the left atrium is opened, and the left ventricle is vented via a left ventricle vent (LV vent ).…”

A single‐center long‐term experience with marginal donor utilization for heart transplantation

“…3 New strategies are required to implement the donor pool including the expansion of criteria for acceptance of organ donor, the use of non heart-beating donors, and the development of optimal preservation and perfusion techniques for the reconditioning of the heart after cardiac arrest. 4,5 While reluctance exists in accepting marginal donors in consideration of higher incidence of primary graft dysfunction (PGD) and worse survival, waiting for an optimal donor especially in higher risk patients is no longer ethically acceptable. The purpose of the present study is to assess the influence of marginal donors on early and long-term results of HT.…”