Warm Beating Orthotopic Heart Transplantation
Perry S. Choi, MD, Alexander K. Reed, MD, Michael R. Ma, MD.
Stanford University, Palo Alto, CA, USA.
Objective(s): To describe the technique for warm beating orthotopic heart transplantation of a donation after circulatory death (DCD) donor.
Methods: A 24-year-old man with Danon Disease and hypertrophic cardiomyopathy status post heart transplantation at age 18 presented with worsening graft vasculopathy and end-stage heart failure. He underwent DCD heart transplantation utilizing the TransMedics Organ Care System to enable ex vivo perfusion. To avoid rearresting the heart, the donor's ascending aorta was cannulated and incorporated into the cardiopulmonary bypass circuit, allowing uninterrupted coronary perfusion and transplantation of a warm, beating donor heart. Video recording of the key steps of this novel technique is presented in the current study.
Results: Cold ischemic time was limited to 38 minutes. Post-bypass echocardiography demonstrated good biventricular function with minimal inotropic. The patient's postoperative course was uncomplicated, and the patient remains well on outpatient follow-up.
Conclusions:
Warm beating heart implantation is an effective approach to DCD heart transplantation that obviates the need for an additional arrest of the heart prior to implantation. Immediate and short-term outcomes are promising, and additional study is necessary to assess potential long-term effects on function of the transplanted heart.
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