Heart Recovery Techniques
Heart Recovery Techniques
A. Donor Types
1. DBD (Donation after Brain Death)
•Traditional and most common
•Heart remains perfused until cross-clamp
•Predictable ischemic time
2. DCD (Donation after Circulatory Death)
•Growing use due to organ shortage
•Requires advanced recovery and perfusion strategies
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B. Heart Recovery Methods
1. Cold Static Storage (CSS)
•Cardioplegic arrest (HTK, Del Nido, UW)
•Stored on ice (4°C)
•Limitations:
•Ischemia-reperfusion injury
•Time-dependent dysfunction
2. Normothermic Machine Perfusion (NMP)
(e.g., TransMedics Organ Care System – OCS Heart)
•Heart is perfused with warm oxygenated blood
•Beating heart during transport
•Advantages:
•Reduced ischemic injury
•Functional assessment (lactate trends, contractility)
•Enables DCD heart transplantation
Key Parameters Monitored
•Arterial/venous lactate
•Aortic pressure
•Coronary flow
•Rhythm and contractility
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C. DCD Heart Recovery Approaches
1.Direct Procurement and Perfusion (DPP)
•Rapid explant after circulatory arrest
•Immediate connection to OCS
2.Normothermic Regional Perfusion (NRP)
•ECMO restores circulation to thoracoabdominal organs
•Cerebral vessels are clamped
•Allows in-situ assessment before explant
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2. Lung Recovery Techniques
A. Lung Donor Types
•DBD
•DCD (widely accepted and effective)
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B. Lung Recovery Methods
1. Cold Static Preservation
•Flush with low-potassium dextran solution (Perfadex)
•Topical cooling
•Inflation at low PEEP
•Limitations:
•Edema
•Primary graft dysfunction (PGD)
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C. Ex Vivo Lung Perfusion (EVLP)
Purpose
•Reconditioning marginal lungs
•Functional assessment before transplant
Systems
•XVIVO
•TransMedics OCS Lung
•Lung Assist
Perfusion Characteristics
•Normothermic (37°C)
•Low-pressure pulmonary perfusion
•Ventilation with protective strategies
Parameters Assessed
•PaO₂/FiO₂ ratio
•Pulmonary vascular resistance
•Lung compliance
•Bronchoscopy findings
•Edema and weight gain
Benefits
•Expands donor pool
•Reduces PGD
•Improves post-transplant outcomes
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3. Combined Heart–Lung Recovery
Key Challenges
•Coordinated ischemic times
•Perfusion strategy compatibility
•Space and logistics in donor OR
Advanced Strategies
•OCS Heart + EVLP Lung
•NRP followed by dual organ recovery
•Sequential explant with priority to heart ischemic time
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4. Future & Experimental Techniques
•Subnormothermic perfusion
•Gene and cytokine modulation during EVLP
•Cellular therapy (MSC delivery)
•Extended preservation beyond 12–24 hours
•AI-assisted organ assessment
Dr.Sam Zeraatian Nejad Davani,Cardiovascular and Transplant surgeon. Advanced Fellow of Thoracic Organs Transplantation Chicago Illinois