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Ex situ heart perfusion (ESHP) has emerged as an important strategy to preserve donation after brain death (DBD) and donation after circulatory death (DCD) donor hearts. Clinically, both DBD and DCD hearts are successfully preserved using ESHP. Viability assessment is currently based on biochemical values, while a reliable method for graft function assessment in a physiologic working mode is unavailable. As functional assessment during ESHP has demonstrated the highest predictive value of outcome post-transplantation, this is an important area for improvement. In this study, a novel method for ex situ assessment of left ventricular function with pressure-volume loop analyses is evaluated. Ovine hearts were functionally evaluated during normothermic ESHP with the novel pressure-volume loop system. This system provides an afterload and adjustable preload to the left ventricle. By increasing the preload and measuring end-systolic elastance, the system could successfully assess the left ventricular function. End-systolic elastance at 60 min and 120 min was 2.8 ± 1.8 mmHg/mL and 2.7 ± 0.7 mmHg/mL, respectively. In this study we show a novel method for functional graft assessment with ex situ pressure-loop analyses during ESHP. When further validated, this method for pressure-volume assessments, could be used for better graft selection in both DBD and DCD donor hearts., Competing Interests: Authors BW, AvP, and FN were employed by XVIVO. ME holds a patent with XVIVO. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Ertugrul, Puspitarani, Wijntjes, Vervoorn, Ballan, van der Kaaij, van Goor, Westenbrink, van der Plaats, Nijhuis, van Suylen and Erasmus.)

Background: Decision-making when offered a donor heart for transplantation is complex, and supportive data describing outcomes according to acceptance or non-acceptance choices are sparse. Our aim was to analyze donor heart acceptance decisions and associated outcomes at a single center, and after subsequent acceptance elsewhere., Methods: This investigation was a retrospective analysis of data obtained from the University of Vienna Medical Center and Eurotransplant centers for the period 2001 to 2015., Results: Our center accepted 31.8% (699 of 2,199) of donor hearts offered. Unlike other centers, the acceptance rate, with or without transplantation, did not increase over time. Of the donor hearts rejected by our center, 38.1% (572 of 1,500) were later accepted elsewhere. Acceptance rates were twice as high for donor hearts initially rejected for non-quality reasons (339 of 601, 56.4%) compared with initial rejection for quality reasons (233 of 899, 25.9%). Three-year patient survival rate was 79% at Vienna; for donor hearts initially rejected by Vienna for non-quality reasons or quality reasons, it was 73% and 63%, respectively (p < 0.001). Outcomes at other centers after transplantation of grafts rejected by Vienna varied according to the reason for rejection, with good 3-year survival rates for rejection due to positive virology (77%), high catecholamines (68%), long ischemic time (71%), or low ejection fraction (68%), but poor survival was observed for hearts rejected for hypernatremia (46%), cardiac arrest (21%), or valve pathology (50%)., Conclusions: A less restrictive policy for accepting donor hearts at our center, particularly regarding rejection for non-quality reasons or for positive virology, high catecholamine levels, longer ischemic time, or low ejection fraction, could expand our donor pool while maintaining good outcomes., (Copyright © 2018 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)

Abstract A 37-year-old man with end-stage idiopathic dilated cardiomyopathy underwent an orthotopic heart transplant followed by a reoperation with mitral annuloplasty for severe mitral regurgitation. Shortly thereafter, he developed severe tricuspid regurgitation and severe recurrent mitral regurgitation due to annuloplasty ring dehiscence. The dehisced annuloplasty ring was refixated, followed by tricuspid annuloplasty through a right anterolateral thoracotomy. After four years of follow-up, there are no signs of recurrent mitral or tricupid regurgitation and the patient remains in NYHA class II. Pushing the envelope on conventional surgical procedures in marginal donor hearts (both before and after transplantation) may not only improve the patient’s functional status and reduce the need for retransplantation, but it may ultimately alleviate the chronic shortage of donor hearts.

To investigate primary graft function of hearts from circulatory dead donors (DCD) preserved with oxygenated hypothermic machine perfusion (oHMP) (XVIVO Heart preservation system) following either direct procurement and perfusion (DPP) or normothermic regional perfusion (NRP) with subsequent transplantation and correlate graft function to oHMP perfusion parameters. In a porcine model, DCD was instituted with circulatory arrest of 15 min, followed by preservation with either DPP and oHMP or NRP and oHMP. After 180 min preservation, orthotopic heart transplantation (HTX) was performed. Dobutamine and norepinephrine were titrated for inotropic and vasoconstrictive support. After weaning from cardiopulmonary bypass, ventricular function was assessed by pressure-volume admittance and Swan-Ganz catheters. Left ventricular contractility was correlated to available HMP parameters using spearman rank correlation. Functional warm ischemic time (FWIT) was similar between groups (DPP 19±1 and NRP 18±1 min, p = 0.23), while time from withdrawal to oxygenated reperfusion was significantly longer in the DPP group (DPP 39±6 and NRP 21±1 min, p < 0.001). End-oHMP coronary flow was negatively correlated to contractile function, while oxygen uptake was positive correlated contractile function. Delta values of perfusion parameters did not correlate to contractile function. Coronary flow and oxygen extraction during oHMP may be important predictors of early graft contractile function post-HTX from DCD donors. [ABSTRACT FROM AUTHOR]