BACKGROUND: Heart transplantation (HT) from donation after circulatory death (DCD) has yet to achieve wide clinical application despite the encouraging resultsreported recently. In this study we describe 2 cases of successful adult DCD HT performed at our institution using an original protocol. METHODS: Our local abdominal DCD protocol was updated to allow DCD heart procurement, and was accepted by the institutional ethics committee. The main features of the protocol include: pre-mortem insertion of peripheral venoarterial extracorporeal membrane oxygenation cannulas; thoracoabdominal normothermic regional perfusion (NRP) by clamping the 3 aortic arch vessels to exclude cerebral circulation; and in-situ heart resuscitation. The retrieved hearts were directly transplanted into recipients located in an adjoining operating room. RESULTS: The procurement warm ischemic time was 25 minutes for the first donor, and 26 minutes for the second donor. The cold ischemic time was 16 minutes for the first recipient and 17 minutes for the second recipient. The suture time was 30 minutes for the first recipient, and 53 minutes for the second recipient. Both recipients were easily weaned off cardiopulmonary bypass in sinus rhythm and inotropic support. Post-operative evaluation of cardiac function was excellent and the patients were subsequently discharged home. CONCLUSIONS: Transplantation of hearts from DCD donors is now a clinical reality.NRP is a useful tool for resuscitation, reperfusion, and preservation of transplanted hearts. It also offers the opportunity to assess the function and viability of organs before transplantation. However,due to ethical issues, some may object to ante-mortem intervention.
BACKGROUND: Heart transplantation (HT) from donation after circulatory death (DCD) has yet to achieve wide clinical application despite the encouraging resultsreported recently. In this study we describe 2 cases of successful adult DCD HT performed at our institution using an original protocol. METHODS: Our local abdominal DCD protocol was updated to allow DCD heart procurement, and was accepted by the institutional ethics committee. The main features of the protocol include: pre-mortem insertion of peripheral venoarterial extracorporeal membrane oxygenation cannulas; thoracoabdominal normothermic regional perfusion (NRP) by clamping the 3 aortic arch vessels to exclude cerebral circulation; and in-situ heart resuscitation. The retrieved hearts were directly transplanted into recipients located in an adjoining operating room. RESULTS: The procurement warm ischemic time was 25 minutes for the first donor, and 26 minutes for the second donor. The cold ischemic time was 16 minutes for the first recipient and 17 minutes for the second recipient. The suture time was 30 minutes for the first recipient, and 53 minutes for the second recipient. Both recipients were easily weaned off cardiopulmonary bypass in sinus rhythm and inotropic support. Post-operative evaluation of cardiac function was excellent and the patients were subsequently discharged home. CONCLUSIONS: Transplantation of hearts from DCD donors is now a clinical reality.NRP is a useful tool for resuscitation, reperfusion, and preservation of transplanted hearts. It also offers the opportunity to assess the function and viability of organs before transplantation. However,due to ethical issues, some may object to ante-mortem intervention.
Authors: Emad Alamouti-Fard; Pankaj Garg; Ishaq J Wadiwala; John H Yazji; Mohammad Alomari; Md Walid Akram Hussain; Mohamed S Elawady; Samuel Jacob Journal: Cureus Date: 2022-06-29
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Authors: Alex Manara; Sam D Shemie; Stephen Large; Andrew Healey; Andrew Baker; Mitesh Badiwala; Marius Berman; Andrew J Butler; Prosanto Chaudhury; John Dark; John Forsythe; Darren H Freed; Dale Gardiner; Dan Harvey; Laura Hornby; Janet MacLean; Simon Messer; Gabriel C Oniscu; Christy Simpson; Jeanne Teitelbaum; Sylvia Torrance; Lindsay C Wilson; Christopher J E Watson Journal: Am J Transplant Date: 2020-01-27 Impact factor: 8.086
Authors: Vincent Tchana-Sato; Arnaud Ancion; Jean Olivier Defraigne; Patrizio Lancellotti; Julien Tridetti; Natzi Sakalihasan; Marie Pierre Hayette; Olivier Detry; Philippe Delvenne; Philippe Amabili; Marc Senard; Olivier Hougrand; Delphine Szecel; Jean-Paul Lavigne; Elie Minga Lowampa; Charlotte Ponte; Isabelle Maquoi; Philippe Morimont; Melissa Van Den Bulck; Marie Helene Delbouille Journal: BMC Infect Dis Date: 2021-01-20 Impact factor: 3.090
Authors: Beatriz Domínguez-Gil; Nancy Ascher; Alexander M Capron; Dale Gardiner; Alexander R Manara; James L Bernat; Eduardo Miñambres; Jeffrey M Singh; Robert J Porte; James F Markmann; Kumud Dhital; Didier Ledoux; Constantino Fondevila; Sarah Hosgood; Dirk Van Raemdonck; Shaf Keshavjee; James Dubois; Andrew McGee; Galen V Henderson; Alexandra K Glazier; Stefan G Tullius; Sam D Shemie; Francis L Delmonico Journal: Intensive Care Med Date: 2021-02-26 Impact factor: 17.440
Authors: Silvia Sánchez-Cámara; Mari C Asensio-López; Mario Royo-Villanova; Fernando Soler; Rubén Jara-Rubio; Jose Francisco Garrido-Peñalver; Eduardo Pinar; Álvaro Hernández-Vicente; Jose Antonio Hurtado; Antonio Lax; Domingo A Pascual-Figal Journal: Am J Transplant Date: 2022-02-21 Impact factor: 9.369