Ex Vivo Heart Perfusion for Cardiac Transplantation Allowing for Prolonged Perfusion Time and Extension of Distance Traveled for Procurement of Donor Hearts: An Initial Experience in the United States

Authors

Ameesh Isath, Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY.
Suguru Ohira, Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, NY.Follow
Avi Levine, Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY.Follow
Stephen Pan, Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY.Follow
Chhaya Aggarwal-Gupta, Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY.Follow
Gregg M. Lanier, Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY.Follow
Kevin Wolfe, Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, NY.
David Spielvogel, Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, NY.
Alan Gass, Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY.Follow
Masashi Kai, Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, NY.Follow

Author Type(s)

Resident/Fellow, Faculty

DOI

10.1097/TXD.0000000000001455

Journal Title

Transplantation Direct

First Page

e1455

Document Type

Article

Publication Date

3-1-2023

Department

Medicine

Second Department

Surgery

Disciplines

Medicine and Health Sciences

Abstract

UNLABELLED: Scarcity of donor hearts continues to be a challenge for heart transplantation (HT). The recently Food and Drug Administration-approved Organ Care System (OCS; Heart, TransMedics) for ex vivo organ perfusion enables extension of ex situ intervals and thus may expand the donor pool. Because postapproval real-world outcomes of OCS in HT are lacking, we report our initial experience. METHODS: We retrospectively reviewed consecutive patients who received HT at our institution in the post-Food and Drug Administration approval period from May 1 to October 15, 2022. Patients were divided into 2 groups: OCS versus conventional technique. Baseline characteristics and outcomes were compared. RESULTS: A total of 21 patients received HT during this period, 8 using OCS and 13 conventional techniques. All hearts were from donation after brain death donors. The indication for OCS was an expected ischemic time of >4 h. Baseline characteristics in the 2 groups were comparable. The mean distance traveled for heart recovery was significantly higher in the OCS group (OCS, 845 ± 337, versus conventional, 186 ± 188 mi;  < 0.001), as was the mean total preservation time (6.5 ± 0.7 versus 2.5 ± 0.7 h;  < 0.001). The mean OCS time was 5.1 ± 0.7 h. In-hospital survival in the OCS group was 100% compared with 92.3% in the conventional group ( = 0.32). Primary graft dysfunction was similar in both groups (OCS 12.5% versus conventional 15.4%;  = 0.85). No patient in the OCS group required venoarterial extracorporeal membrane oxygenation support after transplant compared with 1 in the conventional group (0% versus 7.7%;  = 0.32). The mean intensive care unit length of stay after transplant was comparable. CONCLUSIONS: OCS allowed utilization of donors from extended distances that otherwise would not be considered because ischemic time would be prohibitive by conventional technique.

Recommended Citation

Isath, A., Ohira, S., Levine, A., Pan, S., Aggarwal-Gupta, C., Lanier, G. M., Wolfe, K., Spielvogel, D., Gass, A., & Kai, M. (2023). Ex Vivo Heart Perfusion for Cardiac Transplantation Allowing for Prolonged Perfusion Time and Extension of Distance Traveled for Procurement of Donor Hearts: An Initial Experience in the United States. Transplantation Direct, 9 (3), e1455. https://doi.org/10.1097/TXD.0000000000001455