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Pradegan N, Di Pasquale L, Di Perna D, Gallo M, Lucertini G, Gemelli M, Beyerle T, Slaughter MS, Gerosa G. Ex vivo heart perfusion: an updated systematic review. Heart Fail Rev 2024; 29:1079-1096. [PMID: 39093495 DOI: 10.1007/s10741-024-10420-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/09/2024] [Indexed: 08/04/2024]
Abstract
Due to the discrepancy between patients awaiting a heart transplant and the availability of donor hearts, strategies to expand the donor pool and improve the transplant's success are crucial. This review aims to summarize current knowledge on the ex vivo heart preservation (EVHP) experience as an alternative to standard cold static storage (CSS). EVHP techniques can improve the preservation of the donor's heart before transplantation and allow for pre-transplant organ evaluation.
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Affiliation(s)
- Nicola Pradegan
- Cardiac Surgery Unit, Cardio-thoraco-vascular and Public Health Department, Padova University Hospital, Padua, Italy
| | - Luigi Di Pasquale
- Division of Congenital Cardiovascular Surgery, Pediatric Heart Centre and Children's Research Centre, University Children's Hospital Zürich, Zurich, Switzerland
| | - Dario Di Perna
- Centre Hospitalier Annecy Genevois, Épagny-Metz-Tessy, France
| | - Michele Gallo
- Department of Cardiothoracic Surgery, University of Louisville, 201 Abraham Flexner Way, Suite 1200, Louisville, KY, 40202, USA.
| | - Giovanni Lucertini
- Cardiac Surgery Unit, Cardio-thoraco-vascular and Public Health Department, Padova University Hospital, Padua, Italy
| | - Marco Gemelli
- Cardiac Surgery Unit, Cardio-thoraco-vascular and Public Health Department, Padova University Hospital, Padua, Italy
| | - Thomas Beyerle
- Department of Cardiothoracic Surgery, University of Louisville, 201 Abraham Flexner Way, Suite 1200, Louisville, KY, 40202, USA
| | - Mark S Slaughter
- Department of Cardiothoracic Surgery, University of Louisville, 201 Abraham Flexner Way, Suite 1200, Louisville, KY, 40202, USA
| | - Gino Gerosa
- Cardiac Surgery Unit, Cardio-thoraco-vascular and Public Health Department, Padova University Hospital, Padua, Italy
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Jia S, Caranasos TG, Kumar PA. Pro: Advantages of Using TransMedics Organ Care System Heart in Heart Transplantation. J Cardiothorac Vasc Anesth 2024; 38:569-572. [PMID: 38042742 DOI: 10.1053/j.jvca.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/28/2023] [Accepted: 11/01/2023] [Indexed: 12/04/2023]
Affiliation(s)
- Shawn Jia
- University of North Carolina School of Medicine, Chapel Hill, NC.
| | - Thomas G Caranasos
- Department of Surgery, Division of Cardiothoracic Surgery, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Priya A Kumar
- University of North Carolina School of Medicine, Chapel Hill, NC; Outcomes Research Consortium, Cleveland, OH
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Park C, Singh M, Saeed MY, Nguyen CT, Roche ET. Biorobotic hybrid heart as a benchtop cardiac mitral valve simulator. DEVICE 2024; 2:100217. [PMID: 38312504 PMCID: PMC10836162 DOI: 10.1016/j.device.2023.100217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
In this work, we developed a high-fidelity beating heart simulator that provides accurate mitral valve pathophysiology. The benchtop platform is based on a biorobotic hybrid heart that combines preserved intracardiac tissue with soft robotic cardiac muscle providing dynamic left ventricular motion and precise anatomical features designed for testing intracardiac devices, particularly for mitral valve repair. The heart model is integrated into a mock circulatory loop, and the active myocardium drives fluid circulation producing physiological hemodynamics without an external pulsatile pump. Using biomimetic soft robotic technology, the heart can replicate both ventricular and septal wall motion, as well as intraventricular pressure-volume relationships. This enables the system to recreate the natural motion and function of the mitral valve, which allows us to demonstrate various surgical and interventional techniques. The biorobotic cardiovascular simulator allows for real-time hemodynamic data collection, direct visualization of the intracardiac procedure, and compatibility with clinical imaging modalities.
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Affiliation(s)
- Clara Park
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology; Cambridge, MA, USA 02139
- Department of Mechanical Engineering, Massachusetts Institute of Technology; Cambridge, MA, USA 02139
| | - Manisha Singh
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology; Cambridge, MA, USA 02139
| | - Mossab Y. Saeed
- Department of Cardiac Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA 02115
| | - Christopher T. Nguyen
- Cardiovascular Research Center, Massachusetts General Hospital; Charlestown, MA, USA 02114
- Cardiovascular Innovation Research Center, Heart Vascular Thoracic Institute, Cleveland Clinic; Cleveland, OH, USA 44195
- Imaging Sciences, Imaging Institute, Cleveland Clinic; Cleveland, OH, USA 44195
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic; Cleveland, OH, USA 44196
| | - Ellen T. Roche
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology; Cambridge, MA, USA 02139
- Department of Mechanical Engineering, Massachusetts Institute of Technology; Cambridge, MA, USA 02139
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Wayda B, Angleitner P, Smits JM, van Kins A, Berchtold-Herz M, De Pauw M, Erasmus ME, Gummert J, Hartyanszky I, Knezevic I, Laufer G, Milicic D, Rega F, Schulze PC, van Caeneghem O, Khush KK, Zuckermann AO. Disparities in donor heart acceptance between the USA and Europe: clinical implications. Eur Heart J 2023; 44:4665-4674. [PMID: 37936176 PMCID: PMC10659950 DOI: 10.1093/eurheartj/ehad684] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 07/24/2023] [Accepted: 10/04/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND AND AIMS Given limited evidence and lack of consensus on donor acceptance for heart transplant (HT), selection practices vary widely across HT centres in the USA. Similar variation likely exists on a broader scale-across countries and HT systems-but remains largely unexplored. This study characterized differences in heart donor populations and selection practices between the USA and Eurotransplant-a consortium of eight European countries-and their implications for system-wide outcomes. METHODS Characteristics of adult reported heart donors and their utilization (the percentage of reported donors accepted for HT) were compared between Eurotransplant (n = 8714) and the USA (n = 60 882) from 2010 to 2020. Predictors of donor acceptance were identified using multivariable logistic regression. Additional analyses estimated the impact of achieving Eurotransplant-level utilization in the USA amongst donors of matched quality, using probability of acceptance as a marker of quality. RESULTS Eurotransplant reported donors were older with more cardiovascular risk factors but with higher utilization than in the USA (70% vs. 44%). Donor age, smoking history, and diabetes mellitus predicted non-acceptance in the USA and, by a lesser magnitude, in Eurotransplant; donor obesity and hypertension predicted non-acceptance in the USA only. Achieving Eurotransplant-level utilization amongst the top 30%-50% of donors (by quality) would produce an additional 506-930 US HTs annually. CONCLUSIONS Eurotransplant countries exhibit more liberal donor heart acceptance practices than the USA. Adopting similar acceptance practices could help alleviate the scarcity of donor hearts and reduce waitlist morbidity in the USA.
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Affiliation(s)
- Brian Wayda
- Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, CA
| | - Philipp Angleitner
- Department of Cardiac Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna A-1090, Austria
| | | | | | | | - Michel De Pauw
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Michiel E Erasmus
- Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan Gummert
- Department of Cardiovascular and Thoracic Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany
| | | | - Ivan Knezevic
- Department of Cardiovascular Surgery, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Guenther Laufer
- Department of Cardiac Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna A-1090, Austria
| | - Davor Milicic
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
| | - Filip Rega
- Department of Cardiac Surgery, Katholieke Universiteit Leuven, Leuven, Belgium
| | - P Christian Schulze
- Department of Internal Medicine I, Jena University Hospital—Friedrich Schiller University Jena, Am Klinikum 1, Jena, Germany
| | - Olivier van Caeneghem
- Department of Cardiac Research, Université Catholique de Louvain Clinique Saint-Luc, Brussels, Belgium
| | - Kiran K Khush
- Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, CA
| | - Andreas O Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna A-1090, Austria
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Kothari P. Ex-Vivo Preservation of Heart Allografts—An Overview of the Current State. J Cardiovasc Dev Dis 2023; 10:jcdd10030105. [PMID: 36975869 PMCID: PMC10054234 DOI: 10.3390/jcdd10030105] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/17/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
As heart transplantation continues to be the gold-standard therapy for end-stage heart failure, the supply-demand imbalance of available organs worsens. Until recently, there have been no advances in increasing the donor pool, as prolonged cold ischemic time excludes the use of certain donors. The TransMedics Organ Care System (OCS) allows for ex-vivo normothermic perfusion, which allows for a reduction of cold ischemic time and allows for long-distance procurements. Furthermore, the OCS allows for real-time monitoring and assessment of allograft quality, which can be crucial for extended-criteria donors or donation after cardiac death (DCD) donors. Conversely, the XVIVO device allows for hypothermic perfusion to preserve allografts. Despite their limitations, these devices have the potential to alleviate the supply-demand imbalance in donor availability.
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Affiliation(s)
- Perin Kothari
- School of Medicine, Stanford University, Stanford, CA 94305, USA
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Hwang NC, Sivathasan C. Review of Postoperative Care for Heart Transplant Recipients. J Cardiothorac Vasc Anesth 2023; 37:112-126. [PMID: 36323595 DOI: 10.1053/j.jvca.2022.09.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 09/10/2022] [Accepted: 09/14/2022] [Indexed: 11/11/2022]
Abstract
The early postoperative management strategies after heart transplantation include optimizing the function of the denervated heart, correcting the causes of hemodynamic instability, and initiating and maintaining immunosuppressive therapy, allograft rejection surveillance, and prophylaxis against infections caused by immunosuppression. The course of postoperative support is influenced by the quality of allograft myocardial protection prior to implantation and reperfusion, donor-recipient heart size matching, surgical technique of orthotopic heart transplantation, and patient factors (eg, preoperative condition, immunologic compatibility, postoperative vasomotor tone, severity and reversibility of pulmonary vascular hypertension, pulmonary function, mediastinal blood loss, and end-organ perfusion). This review provides an overview of the early postoperative care of recipients and includes a brief description of the surgical techniques for orthotopic heart transplantation.
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Affiliation(s)
- Nian Chih Hwang
- Department of Anaesthesiology, Singapore General Hospital, Singapore; Department of Cardiothoracic Anesthesia, National Heart Centre, Singapore.
| | - Cumaraswamy Sivathasan
- Mechanical Cardiac Support and Heart Transplant Program, Department of Cardiothoracic Surgery, National Heart Centre, Singapore
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Reichart B, Hagl C, Brenner P, Michel S. Eine persönliche (aber wahre) Geschichte der Herztransplantation in Deutschland. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2022. [DOI: 10.1007/s00398-021-00481-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bryner BS, Schroder JN, Milano CA. Heart transplant advances: Ex vivo organ-preservation systems. JTCVS OPEN 2021; 8:123-127. [PMID: 36004090 PMCID: PMC9390583 DOI: 10.1016/j.xjon.2021.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/22/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Benjamin S. Bryner
- Address for reprints: Benjamin S. Bryner, MD, DUMC 3867, Durham, NC 27710
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Affiliation(s)
- David A Baran
- From the Advanced Heart Failure, Transplant and MCS Center, Sentara Heart Hospital, Norfolk, Virginia
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10
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Stehlik J, Mehra MR. Secular changes in organ donor profiles and impact on heart and lung transplantation. J Heart Lung Transplant 2020; 39:997-1002. [PMID: 32896477 DOI: 10.1016/j.healun.2020.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Josef Stehlik
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
| | - Mandeep R Mehra
- Department of Medicine, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts
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