• Aravind Krishnan, Stefan Elde, Chawannuch Ruaengsri, Brandon A Guenthart, Yuanjia Zhu, Moeed Fawad, Anson Lee, Maria Currie, Michael R Ma, William Hiesinger, Yasuhiro Shudo, John Ward MacArthur, and WooY JosephYJDepartment of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif; Department of Bioengineering, Stanford University School of Engineering, Stanford, Calif. Electronic address: joswoo@stanford.edu..
• Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif.
• J. Thorac. Cardiovasc. Surg. 2024 Aug 5.

ObjectiveEx vivo normothermic perfusion of cardiac allografts has expanded the donor pool for heart transplant. Using a beating heart implantation method avoids the second cardioplegic arrest and subsequent ischemia-reperfusion injury typically associated with ex vivo heart perfusion. We sought to describe our institutional experience with beating heart transplantation.MethodsThis was a single-institution retrospective study of adult patients who underwent heart transplantation using ex vivo heart perfusion (EVHP) and a beating heart implantation technique between October 2022 and March 2024. Primary outcomes of interest included survival, initiation of mechanical circulatory support, and rejection. A subanalysis of our institutional series of nonbeating deceased after circulatory death (DCD) heart transplantations was performed as well.ResultsTwenty-four patients underwent isolated heart transplantation with the use of ex vivo heart perfusion and beating heart implantation between October 2022 and March 2024; 21 (87.5%) received hearts from DCD donors, and 3 (12.5%) received hearts from deceased after brain death (DBD) donors. The median duration of follow-up was 192 days (interquartile range [IQR], 124-253.5 days), and 23 out of 24 patients (95.8%) were alive at last follow-up. No patients required initiation of mechanical circulatory support. The majority of patients had pathologic grade 0 rejection at the time of biopsy (n = 16; 66.7%), and the median cell-free DNA percent was 0.04% (IQR, 0.04%-0.09%). The rate of mechanical circulatory support initiation in the 22-patient nonbeating DCD heart transplant cohort was significantly higher, at 36.4% (P < .005).ConclusionsA beating heart implantation technique can be used for transplantation of DCD and DBD hearts on EVHP and is associated with excellent survival and low levels of rejection.Copyright © 2024 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

5 keywords...

hide…