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J. Thorac. Cardiovasc. Surg. · Aug 2024
Survival, Function, and Immune Profiling after Beating Heart Transplantation.
- 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; Department of Bioengineering, Stanford University School of Engineering. Electronic address: joswoo@stanford.edu..
- Department of Cardiothoracic Surgery, Stanford University School of Medicine.
- J. Thorac. Cardiovasc. Surg. 2024 Aug 5.
ObjectiveEx-vivo normothermic perfusion of cardiac allografts has expanded the donor pool. Utilizing 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 utilizing 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 sub-analysis of our institutional series of non-beating DCD heart transplantation was also performed.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%) patients received hearts from DBD donors. Median follow-up was 192 days (interquartile range of 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 pathological grade 0 rejection at the time of biopsy (n=16, 66.7%), and the median cell-free DNA percent was 0.04% (interquartile range 0.04-0.09). The rate of mechanical circulatory support initiation in the 22-patient non-beating DCD heart transplant cohort was significantly higher at 36.4% (p<0.005).ConclusionsA beating heart implantation technique can be used on DCD and DBD hearts on EVHP and is associated with excellent survival and low levels of rejection.Copyright © 2024. Published by Elsevier Inc.
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