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Objectives: There is limited knowledge regarding the specific interrelationships between urgent coronary artery bypass graft (U-CABG) surgery and postoperative acute kidney injury (AKI). We aimed to (1) analyze the impact of urgent CABG (U-CABG) on the incidence and severity of postoperative AKI, (2) estimate the influence of AKI after U‑CABG or elective CABG (E-CABG) on mortality and (3) identify risk factors for AKI depending on the urgency of operation. Results: U‑CABG patients showed a higher incidence of AKI (49.8% vs. E‑CABG: 39.7%; p= 0.026), especially for higher AKI stages 2 + 3. In-hospital mortality was higher in U‑CABG patients (12.6%) compared to E‑CABG patients (2.3%; p< 0.001). The impact of AKI on mortality did not differ, but showed a strong coherency between higher AKI stages (2 + 3) and mortality (stage 1: OR 2.409, 95% CI 1.017–5.706; p= 0.046 vs. stage 2 + 3: OR 5.577; 95% CI 2.033–15.3; p= 0.001). Univariate logistic regression analysis revealed that preoperative renal impairment, peripheral vascular disease and transfusion of more than two red blood cell concentrates were predictors for postoperative AKI in both groups. Conclusions: U‑CABG is a risk factor for postoperative AKI and even “mild” AKI leads to a significantly higher mortality. Hence, the prevention of modifiable risk factors might reduce the incidence of postoperative AKI and thus improve outcome.

The Na,K-ATPase (NKA) is necessary for maintaining the resting membrane potential by transporting Na+and K+ions across the cell membrane. Although its 3 isoforms expressed in human heart (α1β1, α2β1, and α3β1) possess similar biochemical properties, their specific functions in human tissues remain unknown. In our search for an isoform-specific agent, which can serve to identify isoform-specific functions, we examined 8-methoxycoumestrol in its ability to inhibit the NKA and to produce inotropism in connection with the possibility to identify the NKA isoform-specific functions.

Zusammenfassung: Erhhte Spender-Serumnatriumspiegel (SSNS) ist ein Phnomen, auf das man oft beim Management von hirntoten Spendern trifft. Die klinische Relevanz fr das Outcome der Empfnger ist jedoch weniger gut untersucht. Wir haben den Einfluss von erhhten Spender-Serumnatriumspiegeln auf das Outcome nach Herztransplantation anhand von 1800 herztransplantierten Patienten untersucht.Methoden: Die Daten wurden in einer retrospektiven Analyse der Jahre 1989 bis 2005 zusammengetragen. Die Transplantationen wurden in drei deutschen Transplantationszentren durchgefhrt. Die gemeinsame Datenbank beinhaltete den SSNS bei der Beschaffung des Organs, Empfnger- und Spenderalter, Ischmiezeit, primres Transplantatversagen und berleben.Resultate: Der durchschnittliche SSNS war 147,710,3 l/l (Bereich von 111–208 l/l). Die Empfnger wurden in 4 Gruppen unterteilt mit den Perzentilen 141, 147 und 154 l/l. Daraus ergab sich fr A ein SSNS: 135,84,4, fr B: 143,61,7, fr C: 149,71,9, und fr D: 161,37,7 l/l. Primres Transplantatversagen trat in 2,6% der Patienten auf, darunter in Gruppe A: 2,8, B: 2,8, C: 3,7 and D: 1,4% (P=n. s.). Die mittleren 5- und 10-Jahres-berlebensraten waren 70,9% (57,6%), darunter fr A: 71,1% (53,86%), B: 69,3% (53,9%), C: 72,7% (61,0%), und fr D: 71,2% (62,4%) (P=n. s.). In einer Multivarianzanalyse zeigte sich fr das Empfngeralter (P=0,002), die Ischmiezeit (P=0,002) und das Spenderalter (P=0,009) ein signifikanter Einfluss auf die postoperativen Ergebnisse. Der SSNS war kein individueller Risikofaktor in der Multivarianzanalyse.Ergebnis: Es zeigte sich kein Einfluss des Spender-Serumnatriumspiegels, weder auf die frh-postoperativen Ergebnisse, noch auf das Langzeitoutcome. Dies besagt, dass Herzen von Spendern mit erhhten Natriumspiegeln erfolgreich und mit guten Resultaten transplantiert werden knnen.

BACKGROUND: Elevated donor serum sodium is a phenomenon often encountered in the management of brain dead donors. The clinical relevance on recipient outcome is less examined. We investigated the impact of elevated donor serum sodium levels (DSL) on outcome after heart transplantation in 1800 heart transplantations. METHODS: Data was conducted in a retrospective analysis from 1989 until 2005. The transplantations were performed at three German heart transplant centers. The joined database included DSL at the time of organ procurement, recipient and donor age, ischemia time, primary graft failure and survival data. RESULTS: Mean DSL was 147.7 10.3 l/l (range 111 - 208 l/l). Recipients were divided into 4 groups with percentiles of 141, 147, and 154 l/l resulting in DSL of A: 135.8 4.4, B: 143.6 1.7, C: 149.7 1.9, and D: 161.3 7.7 l/l for the four quartiles. Primary graft failure ocurred in 2.6 % of the patients with A: 2.8 %, B: 2.8 %, C: 3.7% and D: 1.4 % ( P = n.s.). Mean 5- and 10-year-survival rates were 70.9 % (57.6 %) with A: 71.1 % (53.86 %), B: 69.3 % (53.9 %), C: 72.7 % (61.0 %), D: 71.2 % (62.4 %), respectively ( P = n. s.). In a multivariate analysis a significant impact on postoperative results could be revealed for recipient age ( P = 0.002), ischemia time ( P = 0.002) and donor age ( P = 0.009). DSL were no individual risk factor in the multivariate analysis. CONCLUSION: There was no impact of donor serum sodium levels neither on early postoperative results, nor on long-term outcome indicating that cardiac allografts from donors with elevated sodium levels might be transplanted successfully, achieving favourable results.

Seit dem ersten erfolgreichen Ersatz einer Aortenklappe mit Hilfe einer mechanischen Prothese in Jahre 1960 hat es eine rasante Entwicklung neuer Materialien und Techniken gegeben. Dennoch weisen alle herkömmlichen Klappen Probleme auf. Wesentlich sind hier thrombembolische oder hämorrhagische Komplikationen, Klappenendokarditis und ein nicht physiologisches Flussprofil. Der Einsatz menschlicher kryokonservierter Herzklappentransplantate (Homografts) hat sich in der Therapie von Herzklappenerkrankungen bis heute zu einem sicheren Verfahren in der Kardiochirurgie etabliert. Obwohl der ideale Herzklappenersatz noch definiert werden muss, kommt der humane Homograft diesem im Vergleich zu den mechanischen oder biologischen Ventilen am nächsten. Homografts gewährleisten eine nahezu normale Anatomie mit guten hämodynamischen Eigenschaften in Ruhe und unter Belastung. Aufgrund des sehr geringen Auftretens thrombembolischer Ereignisse ist eine Antikoagulanzientherapie in der Regel nicht notwendig. Besonders bei Endokarditis haben sich Homografts wegen ihrer niedrigen Reinfektionsrate als besonders resistent gegenüber Infektionen gezeigt. Homografts sind jedoch entsprechend dem Organspendermangel in der gesamten Transplantationsmedizin nur begrenzt verfügbar, besitzen ein immunologisches Potenzial, unterliegen durch Verkalkung erneut degenerativen Prozessen und haben daher beschränkte Langzeitfunktion. Zusammenfassend kann gesagt werden, dass Homografts für eine bestimmte Gruppe von Patienten attraktivere Alternativen zu den mechanischen oder xenobiologischen Prothesen darstellen. Die behandelnden Ärzte sollten über die verfügbaren Implantate, die Operationsmethoden und die zu erwartenden Ergebnisse informiert sein. Since the first successful aortic valve replacement with a prosthetic heart valve in 1960, tremendous advances in material and techniques have been made to create the ideal artificial heart valve. Nevertheless, all commonly used valve protheses show thrombotic and thrombembolic events, endocarditis, and no-physiological hemodynamics. The use of cryopreserved human heart valves (homografts) from tissue donors has become established in clinical routine of cardiac surgery as a safe procedure. Although, the ideal heart valve substitute still has to be defined, the human homograft compared to mechanical or xenobiological prostheses represent the most desired properties. They insure nearly normal anatomy with very good hemodynamic performance. Due to the absence of thrombotic and thrombembolic events anticoagulation can be avoided. Especially in patients with endocarditis utilization of homografts has been shown to be resistant against infection with low reinfection rates. However, homografts are of limited availability, they induce an immunologic response, the valves undergo degeneration limiting their durability and making reoperation necessary. In conclusion, for a selected group of patients homografts represent attractive alternatives to the implantation of mechanical or xenobiological prostheses, which is why physicians should know about the available valve substitutes, operative techniques and expecting results.

At the time of implantation, tissue-engineered constructs should resemble native tissues as closely as possible. At present, histology and biochemical methods are commonly used to compare tissue-engineered constructs with native tissue. A ProteinChip system based on surface-enhanced laser desorption/ionization time of flight mass spectrometry (SELDI) has been developed that allows visualization of complex protein profiles from biological samples. The aim of this study was to determine whether the ProteinChip system is a suitable tool with which to compare the protein expression profiles of tissue-engineered aortic blood vessels with native tissues. Tissue-engineered blood vessel substitutes were fabricated with poly-4-hydroxybutyrate scaffolds, ovine vascular cell seeding, and dynamic tissue culture conditions. Engineered, ovine aortic, and carotid tissues were homogenized and total protein was extracted. Samples were analyzed on ProteinChip arrays. Analysis yielded reproducible protein profiles from all samples. About 150 distinct protein peaks were detected. Comparative analysis with ProteinChip software revealed that the protein profiles from native aorta and native carotid arteries were similar whereas early tissue-engineered samples displayed more distinct deviations. In conclusion, ProteinChip system technology is rapid, reproducible, and highly sensitive in highlighting differentially expressed proteins in tissue-engineered blood vessel substitutes.

Fresh frozen plasma (FFP) substitution is currently standard practise in cardiac surgery. In this study we investigate whether elective coronary artery bypass grafting (CABG) surgery is feasible without the administration of blood products compared to the substitution of fresh frozen plasma.

Patients with primary pulmonary hypertension (PPHT) have a worse natural outcome compared with those with secondary pulmonary hypertension in Eisenmenger's syndrome (ES) and chronic pulmonary embolism (CPE). Lung transplantation (SLTx, DLTx, HLTx) still remains the only therapeutical option for patients with this type of endstage lung disease.

The introduction of Euro-Collins solution with its intracellular electrolyte composition has allowed for clinically accepted pulmonary preservation for up to 7 h of ischemic time. In recent years several alternative solutions have been developed for the improvement of pulmonary preservation. Celsior is an extracellular solution which has significantly reduced the ischemia/reperfusion (IR)-induced pulmonary damage in animal studies. So far, no larger experimental studies exist concerning the influence of Celsior on pulmonary gas exchange following IR.

Aneurysms of the aortic root lead to aortic valve incompetence due to dilatation of the sinotubular junction and annuloaortic ectasia. Reimplantation of the native, structurally intact aortic valve within a Dacron tube graft corrects annular ectasia as well as dilatation of sinotubular junction and aortic sinuses. Durability of this valve repair with respect to increased mechanical stress on valve cusps is discussed controversially and is yet unknown.

Background:Minimally invasive direct coronary artery bypass (MIDCAB) grafting without cardipulmonary bypass (CPB) through an anterolateral minithoracotomy has become a promising therapeutical option especially in multimorbid, elderly and reoperative patients with single vessel disease. However, this procedure precludes complete revascularization in multivessel disease because the minithoracotomy limits the surgical access either to anterior or lateral or posterior vessels of the beating heart. To expand the benefits of the MIDCAB concept to patients with multivessel disease, new interdisciplinary approaches have recently been introduced. Methods:Since December 1996, 26 patients (21 male, 5 female, mean age 56.6 ± 18.8 years) underwent a “,hybrid” revascularization performed as a primary MIDCAB procedure for grafting of the left anterior descending artery (LAD) with the left internal mammary artery (LIMA) followed by staged angioplasty and stenting of additional coronary lesions. Results:After MIDCAB grafting, the postoperative course was uneventful in all patients. Coronary re-angiography after a median of 7 days revealed patent and functioning LIMA grafts in all patients. Applying subsequent percutaneous transluminal coronary angioplasty (PTCA) and occasional stenting (n = 8), a total of 31 lesions were treated successfully. Procedure related complications did not occur. All patients remained angina-free and no stress electrocardiographic changes were recorded. Conclusion:Our preliminary results of a “hybrid” approach to myocardial revascularization suggest that this concept is a safe and effective approach of complete revascularization for selected patients with multivessel involvement. Especially elderly and reoperative patients with significant comorbidity may benefit from hybrid procedures avoiding cardiopulmonary bypass and midsternotomy. Einleitung:Die minimalinvasive koronare Bypassoperation (minimally invasive direct coronary artery bypass: “MIDCAB”) ohne Verwendung der Herz-Lungen-Maschine (HLM) über eine anterolaterale Mini-Thorakotomie ist insbesondere für multimorbide und ältere Patienten, jedoch auch bei kardialen Reoperationen zu einer vielversprechenden Therapiealternative bei Vorliegen einer koronaren Eingefäßerkrankung geworden. Allerdings erlaubt dieser Zugang bei koronarer Mehrgefäßerkrankung keine komplette myokardiale Revaskularisation am schlagenden Herzen, da durch die linksseitige Mini-Thorakotomie der chirurgische Zugang auf die Vorderwandgefäße limitiert ist. Um die Vorteile des MIDCAB-Konzeptes – Verzicht auf Sternotomie und HLM – auch Patienten mit koronarer Mehrgefäßerkrankung anbieten zu können, wurde abhängig vom Koronarstatus eine neue Vorgehensweise verfolgt. Methodik:Seit Dezember 1996 wurden 26 Patienten (21 Männer, 5 Frauen, mittleres Alter 56,6 ± 18,8 Jahre) einem sogenannten “Hybrid”-Verfahren unterzogen. Nach primärer MIDCAB-Operation mit Anastomosierung der linken Arteria mammaria interna (LIMA) auf den Ramus interventricularis anterior (RIVA) erfolgte zweizeitig eine perkutane transluminale Angioplastie (PTCA) weiterer stenosierter Koronargefäße. Ergebnisse:Nach unkompliziertem postoperativem Verlauf erfolgte nach 7 Tagen (Median) die erneute Koronarangiographie, die in allen Fällen einen frei durchgängigen und funktionsfähigen LIMA-Bypass zeigte. Mittels PTCA und zusätzlicher Stentimplantation in 8 Fällen wurden weitere 31 Koronarläsionen bei diesen Patienten erfolgreich therapiert. Es traten weder im Zusammenhang mit dem MIDCAB-Eingriff noch verbunden mit der PTCA nennenswerte Komplikationen auf. Alle Patienten waren nach der “Hybrid”-Revaskularisation bei unauffälligem Elektrokardiogramm kardial beschwerdefrei. Schlußfolgerung:Insgesamt scheint ein solches “Hybrid”-Konzept eine sichere und effektive komplette Myokardrevaskularisation für ausgewählte Patienten mit koronarer Mehrgefäßerkrankung zuzulassen. Insbesondere ältere und kardial voroperierte Patienten mit risikoerhöhenden Begleiterkrankungen dürften von einer interdisziplinären Revaskularisation unter Vermeidung von Sternotomie und HLM profitieren.

Objective To investigate the long term outcome and prognostic factors after heart transplantation. Setting University hospital. Subjects 120 heart transplant patients (98 male, 22 female; underlying disease: dilated cardiomyopathy in 69, coronary artery disease in 42, miscellaneous in nine) who had undergone heart transplantation between October 1984 and October 1987. Immunosuppressive treatment was comparable in all patients and rejection episodes were treated in a uniform manner. Methods Functional status, quality of life, and potential predictors for long term survival were investigated. Results Actuarial survival rates were 65% at five years and 48% at 10 years; 58 patients survived > 10 years. The major causes of death were cardiac allograft vasculopathy (39%), acute rejection (18%), infection (11%), and malignancy (11%). Long term survivors had good exercise tolerance assessed by the New York Heart Association classification: 47 (81%) in grade I/II; 11 (19%) in grade III/IV. Echocardiography showed good left ventricular function in 48 patients. On angiography, severe allograft vasculopathy was present in only 16 patients (28%). Renal function was only slightly impaired, with mean (SD) serum creatinine of 148.5 (84.9) μmol/l. Multiple potential predictors of long term survival were analysed but none was found useful. Conclusions Heart transplantation represents a valuable form of treatment. Survival for more than 10 years with a good exercise tolerance and acceptable side effects from immunosuppression can be achieved in about 50% of patients.

In ten cases of clinical human single-lung transplantation, the nontransplanted Euro-Collins-preserved contralateral lungs were examined using electron microscopy to determine the effects of ischaemia on the bronchiolar epithelium. Existing structural damage at the time of transplantation was characterized using this approach, and nine nonpreserved canine single lungs were also investigated to identify the impact of ischaemia. The study revealed a significant correlation between the duration of ischaemia and the mitochondrial surface-to-volume ratio, which can serve as a morphometric criterion for mitochondrial damage, in canine lungs. However, this correlation was not found in the human donor lungs. Further examination of human donor lungs showed slight to moderate damage to the endoplasmic reticulum and nuclear chromatin. In addition, various degrees of damage to mitochondrial structure, ranging from inconspicuous to severe, were found. The mitochondrial surface-to-volume ratio can be considered to be a suitable criterion for the quantification of ischaemic damage of the bronchiolar epithelium under experimental conditions. Ultrastructural analysis of human donor lungs revealed intact bronchiolar epithelial cell structures at the time of transplantation, reflecting adequate organ preservation with Euro-Collins solution.

Pulmonary hypertension (PHT) is a life-threatening complication after isolated heart and lung transplantation. Recent work has shown that inhaled nitric oxide (NO) in combination with inhaled prostaglandin E1 (PGE1) reduce pulmonary hypertension but their influence on cardiac contractility is less well defined.

Colonization of the lung and mediastinal lymph nodes with multi-resistant bacteria, diabetes and malnutrition represent potential risk factors for lung transplantation in cystic fibrosis. We therefore reviewed our experience in this patient population.

Background: Despite increasing knowledge about degree and distribution pattern of intimal hyperplasia in cardiac allograft vasculopathy, coronary artery remodeling is only poorly understood in this disease. Methods: To evaluate vascular geometry, intravascular ultrasound was used to characterize 57 advanced lesions in 35 consecutive transplant recipients. Lumen, plaque, and vessel area in these target lesions were compared with proximal and distal reference sites. Results and Conclusions: Vascular remodeling by compensatory local vessel enlargement (positive remodeling) and circumscript vascular constriction (negative remodeling) could be demonstrated. Plaque area in stenotic lesions was significantly increased compared with the mean reference site (5.6 +/- 3.0 mm^2 versus 2.8 +/- 1.5 mm^2, p < 0.001); however, inadequate compensatory enlargement rather than intimal hyperplasia was shown to be the most important predictor of luminal obstruction (r = 0.77, p < 0.001). (Am Heart J 1998;135:628-33.)

Cardiac allograft vascular disease is characterized by diffuse and multifocal heterogeneous myointimal hyperplasia with or without vascular remodeling. Catheter-based interventions are indicated in selected patients. This study documents our experience with percutaneous transluminal coronary angioplasty and coronary stents (n=48) in a group of 27 patients 5.7+/-2.9 years after heart transplantation. Early and intermediate results were controlled by angiography and intravascular ultrasound. Conventional percutaneous transluminal coronary angioplasty resulted in a mild and mostly inadequate gain in luminal dimensions (lumen area: 3.17+/-0.92 mm^2 to 3.70+/-1.21 mm^2; minimal lumen diameter: 1.84+/-0.23mm to 2.04+/-0.36 mm). Coronary stenting led to a further improvement of luminal gain (lumen area: 3.70+/-1.21 mm^2 to 5.86+/-1.76 mm^2; minimal lumen diameter: 2.04+/-0.36 mm to 2.53+/-0.38 mm). These results were stabilized by application of aspirin and ticlopidine only. There were no stent thromboses or bleeding complications, and early hospital discharge of the patients was possible. At follow-up (mean follow-up period 7.72+/-5.45 months (range 0.50 to 23.13 months) all patients were clinically event free. In six of 24 stented vessels (25%) in 16 patients, significant restenosis (>50%) was found by intravascular ultrasound (n=20) or by angiography (n=4) 6 months after stent placement. We conclude that in eligible cardiac allograft vascular disease lesions primary stenting may be the method of choice. However, further evaluation of the modalities of stent application and different stent designs with respect to long-term survival is necessary.

Extracorporeal membrane oxygenation (ECMO) was used to achieve temporary artificial support in cardiac and pulmonary function in 22 patients from 1987 to September 1990. Standard indications were postcardiotomy cardiogenic shock (n=4), neonatal (n=1) and adult respiratory distress syndrome (n=4). ECMO was also used for extended indications, such as graft failure following heart (n=11) or lung transplantation (n=2). In six of these cases ECMO was instituted as a bridge device to subsequent retransplantation of either the heart (n=4) or one lung (n=2). One out of nine patients supported by ECMO for standard indications, and two out of 13 patients supported for extended indications are long-term survivors. This series illustrates the results with ECMO in emergency situations, in patients under immunosuppressive protocols, or in patients with advanced lung failure requiring almost complete artificial gas exchange. In such complex situations, ECMO does provide stabilization until additional therapeutic measures are in effect. ECMO cannot be recommended for postoperative cardiogenic shock but short-term ECMO support is an accepted method in most cases with graft failure or pulmonary failure or other origin.

Even in the age of extensive aortic replacement special circumstances may warrant the insertion of extraanatomic thoracic aortic bypass grafts. Our experience with 17 patients is analyzed.

The development of coronary vasculopathy is the main determinant of long-term survival in cardiac transplantation. The identification of risk factors, therefore, seems necessary in order to identify possible treatment strategies. Ninety-five out of 397 patients, undergoing orthotopic cardiac transplantation from 10/1985 to 10/1992 were evaluated retrospectively on the basis of perioperative and postoperative variables including age, sex, diagnosis, previous operations, renal function, cholesterol levels, dosage of immunosuppressive drugs (cyclosporin A, azathioprine, steroids), incidence of rejection, treatment with calcium channel blockers at 3, 6, 12, and 18 months postoperatively. Coronary vasculopathy was assessed by annual angiography at 1 and 2 years postoperatively. After univariate analysis, data were evaluated by stepwise multiple logistic regression analysis. Coronary vasculopathy was assessed in 15 patients at 1 (16%), and in 23 patients (24%) at 2, years. On multivariate analysis, previous operations and the incidence of rejections were identified as significant risk factors (P < 0.05), whereas the underlying diagnosis had borderline significance (P = 0.058) for the development of graft coronary vasculopathy. In contrast, all other variables were not significant in our subset of patients investigated. We therefore conclude that the development of coronary vasculopathy in cardiac transplant patients mainly depends on the rejection process itself, aside from patient-dependent factors. Therapeutic measures, such as the administration of calcium channel blockers and regulation of lipid disorders, may therefore only reduce the progress of native atherosclerotic disease in the posttransplant setting.

The MAZE procedure has proven effective for surgically treating atrial fibrillation, but its acceptance has been limited due to the complex dissection pattern. A new simplified operative technique, that comprises two important components of the MAZE procedure, has been evaluated in an established animal model of induced sustained atrial fibrillation.

The treatment of recurrent rejection in heart transplant recipients has been a controversial issue for many years. The intent of this retrospective study was to perform a risk-benefit analysis between treatment strategies with bolus steroids only versus anti-thymocyte globulins (RATG; 1.5 mg/kg q 4 days).

We report the one-stage surgical management in a 68-year-old patient with a renal cell carcinoma with extended intravascular growth into the inferior vena cava combined with severe triple coronary artery disease. After nephrectomy the resection of the intravascular tumor and caval reconstruction were performed in deep hypothermic circulatory arrest. Coronary revascularization was accomplished while rewarming. The postoperative course was uneventful. Nine months after this operation there are no signs of reoccurrence.

Perioperative spasm of the internal mammary artery (IMA) may result in early restriction of bypass flow. Therefore, pharmacological pretreatment is usually suggested. We present a technique of temporary distal occlusion of the transsected IMA using a metal clip. After 1 hour of storage in normal saline (SAL) there were significantly better flow rates compared with proximal application of a bull-dog clamp. No further increase in flow was noticed after submersion of the IMA pedicle in verapamil (VER). This technique easily provides sufficient IMA flow at the time of anastomosis, probably due to continuous endoluminal dilatation of the IMA by blood pressure, and thus avoids pharmacological pretreatment with vasodilators.

In recent years, there is a growing body of evidence that the University of Wisconsin (UW) solution offers many advantages in organ preservation with regard to preservation quality and time. We, therefore, conducted the first European prospective, randomized, clinical trial comparing myocardial performance after preservation with UW and St. Thomas Hospital (ST) solution. Preliminary results indicated superior heart function after preservation with UW solution.