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Survival, Function, and Immune Profiling after Beating Heart Transplantation.
Survival, Function, and Immune Profiling after Beating Heart Transplantation. The Journal of thoracic and cardiovascular surgery Krishnan, A., Elde, S., Ruaengsri, C., Guenthart, B. A., Zhu, Y., Fawad, M., Lee, A., Currie, M., Ma, M. R., Hiesinger, W., Shudo, Y., MacArthur, J. W., Woo, Y. J. 2024Abstract
Ex-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.This 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.Twenty-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).A 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.
View details for DOI 10.1016/j.jtcvs.2024.07.058
View details for PubMedID 39111693