Does the solution used for cold static storage of hearts impact on heart transplant survival?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'For the [cold static storage of donor hearts] does the [cardiac preservation solution] impact on [heart transplant survival]?'. Altogether 182 papers were found using the reported search, of which 9 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. A wide variety of both custom and standardized cardiac preservation solutions are used for the procurement and cold static storage of donor hearts. In heart transplants with shorter cold ischaemic times, survival outcomes appear similar across many of the common cardiac preservation solutions in the long term. However, unspecified cardioplegia (with supraphysiological potassium concentration) is not supported as the final storage solution as it was associated with worse outcomes overall. In the short term, intracellular solutions (<70 mEq/l sodium; including University of Wisconsin solution) may also have better survival outcomes than extracellular solutions. Where extended ischaemic times (>4 h) are necessary or high-risk grafts obtained, the evidence supports University of Wisconsin as the preferred solution. We concluded that choice of cardiac preservation solution could impact both survival and secondary outcomes.