DCD heart transplantation with prolonged functional warm and cold ischemic time using controlled hypothermic preservation: A case report

Vincenzo Tarzia, MD, PhD; Matteo Ponzoni, MD; Marco Gemelli, MD; Nicola Pradegan, MD; Gino Gerosa, MD

JHLT Open (Aug 2024)

DCD heart transplantation with prolonged functional warm and cold ischemic time using controlled hypothermic preservation: A case report

Vincenzo Tarzia, MD, PhD,
Matteo Ponzoni, MD,
Marco Gemelli, MD,
Nicola Pradegan, MD,
Gino Gerosa, MD

Affiliations

Vincenzo Tarzia, MD, PhD: Corresponding author: Vincenzo Tarzia, MD, PhD, Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Via Giustiniani 2, 35128 Padua, Italy.; Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
Matteo Ponzoni, MD: Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
Marco Gemelli, MD: Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
Nicola Pradegan, MD: Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
Gino Gerosa, MD: Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy

Journal volume & issue: Vol. 5
p. 100109

Abstract

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We describe the case of successful heart transplantation following donation after circulatory death (DCD) with a prolonged functional ischemic time (43 minutes), which was performed using the Paragonix SherpaPak Cardiac Transport System (SCTS). Due to a mandatory stand-down period of 20 minutes for the confirmation of circulatory death, DCD heart transplantation has so far been considered prohibitive in Italy. Thanks to the very recent implementation of a new national DCD heart protocol, a 24-year-old male with arrhythmogenic right ventricular cardiomyopathy underwent successful heart transplantation with a DCD graft using thoracoabdominal normothermic regional perfusion via femoral vessel cannulation and use of aortic endo-clamp, followed by sternotomy, aortic cross-clamping, and cardioplegia administration in the aortic root. After graft harvesting, SCTS was used for controlled hypothermic preservation during transportation. This case provides novel insights into the myocardial recovery potential following sustained ischemia and highlights the possibility of further expanding the donor’s pool using DCD hearts even in countries with prolonged stand-down periods required by law.

Published in JHLT Open

ISSN: 2950-1334 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery; Medicine: Internal medicine: Specialties of internal medicine
Website: https://www.sciencedirect.com/journal/jhlt-open

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