HEART PRESERVATION WITH EX-SITU NORMOTHERMIC PERFUSION VERSUS COLD STORAGE: A PROPENSITY SCORE MATCHED ANALYSIS

Background and Aim: Heart preservation with normothermic perfusion (NP) is recommended in expected ischemic time longer than 4 hours, in complex redo recipient or in case of marginal donors. The aim of the retrospective review of our institutional heart transplantation (HTx) registry is the comparison of early outcomes of NP versus cold storage (CS). Methods: From January 2010 to July 2024, 335 consecutive HTx have been performed. Heart preservation was carried out with NP in 22.7% of cases (76/335), while with CS in 77.3% (259/335).After propensity score matching, 54 pairs with no significant residual imbalance were identified. Main early outcomes were compared between groups (NPmatched e CSmatched, respectively). Results: Mean age (57±10 years versus 57±11) and male gender (81.3% vs 80.8%) were similar between groups. Considering unmatched patients, NP showed higher rate of reintervention (50% vs 38%) and mechanical circulatory support (MCS)(23% vs 12%), but similar retransplantation (8% vs 6%); after matching these features resulted well-balanced. Considering matched cohort, graft ischemia time [129(110-149) min vs 248(212-268) min, p<0.05] and cardio-pulmonary bypass time [194(150-235) min vs 207(185-254) min] were significantly lower in NPmatched group (p<0.05). Severe primary graft dysfunction (7% vs 7%), dialysis (19% vs 15%), short-term MCS (11% vs 9%) and 30-day mortality (9% vs 7%) were similar (p>0.05). No differences emerged in terms of 1-year survival (75% vs 82%, log-rank 0.359). Conclusions: Heart preservation with NP allows a significative reduction in ischemic and cardiopulmonary bypass times. Inhospital outcomes are similar to CS, especially in high risk recipients and marginal donors, offering several logistical, technical and educational advantages.