BEATING HEART TRANSPLANTATION: FIRST EXPERIENCE IN ITALY

Background and Aim: Prolonged donor graft ischemia during harvesting and transportation may be responsible of allograft dysfunction after heart transplantation (HTx). Our Center firstly adopted the Organ Care System (OCS) in 2007, being one of the enrolling Centers in the PROCEED-II trial. Since then, we have preserved a total of 87 donor hearts with OCS. Methods: In 2024, we modified the implantation surgical phase in 2 patients. The grafts employed were from donation after brainstem death (DBD) donors, and preserved with the OCS. The cardiopulmonary bypass (CPB) was modified so that the grafts could be perfused through an additional arterial perfusion line. The donor aorta was cannulated and connected to the additional CPB arterial line. The perfusion from the OCS was stopped, the aorta cross-clamped immediately distal to the CBP perfusion line and antegrade flow was initiated. Graft implantation started with the left atrial anastomosis. The aortic anastomosis was then carried out between the two clamps which were released upon completion of the suture. The remainder of operation was concluded as in a standard HTx. Results: At the end of HTx, recipients were weaned from CPB without difficulty. Recipient 1 presented, after 2 days, moderate rejection which resolved after treatment. In Recipient 2 the postoperative course was uncomplicated. Conclusions: This preliminary experience has demonstrated that HTx with a beating heart obtained by DBD is feasible. By eliminating the second period of ischemia could be particularly beneficial, especially when using marginal donors, DCD grafts or long-distance procurements.