Normothermic Ex-Vivo Perfusion for Donor Heart Preservation in Transplantation of Patients Bridged with Ventricular Assist Devices

PURPOSE Recently, it has been shown that survival after heart transplantation is impaired in patients bridged with left ventricular assist devices (LVAD), mostly due to increased rates of primary graft dysfunction (PGD). Ex vivo perfusion (EVP) is a graft preservation technique non-inferior to standard cold storage (CS). It allows to maintain the heart in a beating and perfused status during challenging surgical dissection in LVAD patients undergoing heart transplantation, and to reduce ischemic time potentially lowering the risk of PGD. METHODS Patients bridged on LVAD and transplanted in two European centers (Udine, Italy and Hanover, Germany) since 2016 were included in the study and prospectively followed. Grafts were transported with EVP using the Organ Care System (Transmedics, Andover, MA) in 44 cases and 21 with CS. RESULTS The underlying demographics were not different, except for urgency status (86% vs. 57%, p=0.01) and chronic renal failure (59% vs. 29%, p=0.02) in EVP and CS respectively. Median age was 56(21-71) vs. 54(25-65), p=0.73; male sex was 77% vs. 81%, p=0.50 and most frequent ethiology was dilated cardiomyopathy in 73% vs. 52%, p=0.11. No differences were found in donors characteristics, with the employment of extended criteria donors in many cases (41% vs. 43%, p=0.55).Five extended criteria donor hearts were assessed as non-transplantable while on EVP.The remaining grafts were transported for a mean time of 296±64 min in EVP.Ischemic times were significantly shorter in the EVP group (132±29 vs. 223±48 min, p 96h (25% vs. 33%, p=0.48), of dialysis (66% vs. 52%, p=0.29), revision for bleeding (16% vs. 19%, p=0.50) and ICU stay (6.1-123 vs. 5.1-195 days, p=0.48) were reported. Furthermore, a trend to better survival at mid-term was found (p=0.25) with 88% vs. 76% survival at 3 years. CONCLUSION VAD patients have a high risk of morbidity during HTx. EVP warrants a trend towards improved outcomes in this difficult recipient cohort. The longer available time to perform surgery and the reduced ischemia permit a safer procedure including cases of extended criteria donor employment.