48: Compassionate use of hypothermic oxygenated perfusion (HOPE) of donor hearts

Introduction: Recent clinical evidence has shown that hypothermic oxygenated perfusion (HOPE) of donor heart can reduce the incidence of primary graft dysfunction compared to standard cold static storage and allows to safely and effectively extend donor heart presentation times. Here, we present our initial experience in patients considered unsuitable for transplantation due to surgical site complexity and anticipated unjustifiable risk of loss of donor organ. Methods: Compassionate use of a non-CE-marked device for hypothermic oxygenated perfusion (Xvivo, Sweden) of donor hearts was requested by the regulatory authorities for four patients deemed to be otherwise not suitable for transplantation due to surgical site complexity. Results: For four patients compassionate use was requested, they were successfully transplanted: Case 1 was a 36 years old female, combined heart- and liver transplantation for failing Fontan physiology. Case 2 was a 13 years old female, heart transplantation following mechanical MVR and HM3-implantation for failing Fontan physiology. Case 3 was a 36 years old female, heart transplantation following EXCOR-BVAD for restrictive cardiomyopathy and pulmonary vein stenosis. Case 4 was a 56 years old male, heart transplantation following HM6-implantation and pulmonalis TEA for dilative cardiomyopathy. Time between harvest and reperfusion of the donor organ were 349, 326, 487, and 289 minutes respectively. Graft function was unremarkable. Primary chest closure was obtained in all four patients. Mechanical circulatory support was not needed. Conclusions: The superior graft function achieved with hypothermic oxygenated perfusion may reduce the overall procedural risk of heart transplantation in complex patients, allowing successful transplantation in patients otherwise considered unsuitable for heart transplantation with cold static storage.