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Objectives: Around 2000 heart transplants are performed in Europe annually. The rates of primary graft dysfunction in Europe are among the highest in the world. With increasing demand for organs and the limited supply of donors, novel techniques such as ex vivo normothermic perfusion have garnered incre-asing interest. We present a series of patients who underwent heart transplant at our unit in which we used a novel implantation technique to reduce primary graft dysfunction., Materials and Methods: We compared our experience with the novel method detailed in our article (Glasgow experience group) with a contemporary UK cohort (2015-2016) of patients (control group). We performed multivariable logistic regression to compare the Glasgow experience with the control group with primary graft dysfunction as the outcome measure. We adjusted for donor age, recipient diabetes mellitus, urgent listing status, bypass time, and total ischemic time., Results: Among 194 patients in both cohorts, 140 patients (72.1%) were men and 36 (18.6%) had ischemic cardiomyopathy. The odds ratio of primary graft dysfunction in the control group was 2.99 (95% CI, 1.02- 8.75) compared with the Glasgow experience group., Conclusions: Our novel approach was associated with significant reductions in primary graft dysfunction, with a trend toward improved 1-year survival. Larger studies are needed to show differences after further adjustment for known confounders of primary graft dysfunction. We believe this novel technique is safe, cost-effective, and reproducible.

Primary Graft Dysfunction (PGD) is the leading cause of early mortality after heart transplantation. Several risk factors of PGD have been identified, including; prolonged warm ischaemic time, advanced donor age, gender mismatch and recipient diabetes mellitus. We adopted a novel method of implantation using "antegrade myocardial perfusion (AMP)" during implantation and compared this to the conventional approach. We obtained the retrospective data retrospectively from the Golden Jubilee National Hospital heart transplant database, ClinicalPortal and CIS databases from January/2012-May/2018. Missing data were obtained from the hard copy case notes. We performed AMP utilising continuous cold blood (4-6°C) antegrade cardioplegia to achieve aortic root pressures of 60-70 mmHg. Leucocyte filer was utilised. The infusion would continue with an LV vent insitu until the left atrial and aortic anastomoses were complete. "Hotshot" warm blood was then infused prior to removal of the cross clamp. Multivariable logistic regression with moderate/severe PGD as the outcome measure. Confounders were adjusted for recipient age, total ischaemic time, bypass time, predicted left ventricular (LV) mass mismatch, recipient diabetes mellitus and donor age. A total of 75 patients were included in this study. 44% (n=33) underwent AMP and 56 % (n=42) had orthotopic heart transplantation with the conventional approach. There was no statistically significant difference in age, gender, incidence of diabetes mellitus, preoperative utilisation of mechanical circulatory support between the AMP and the control group. We found that total ischaemia time was significantly shorter in the AMP cohort (154+/-50.2 vs. 181+/-47.1 min, p=0.018). The rate of postoperative VA ECMO support was significantly lower in the AMP cohort (15% vs. 54%, p<0.001). The rate of moderate-severe PGD was significantly lower in the AMP cohort (21% vs. 69%, p<0.001). The odds ratio of PGD in patients in the historical cohort vs AMP was 4.15 (1.21-14.24). Our implantation technique utilising AMP significantly lowers the rate of moderate and severe PGD when compared to the standard implantation technique employed by the historical cohort. [ABSTRACT FROM AUTHOR]