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BACKGROUND: In an effort to address the increasing demand for heart transplantation within the United Kingdom (UK), we established a clinical program of heart transplantation from donation after circulatory-determined death (DCD) donors in 2015. After 5 years, we report the clinical early outcomes and impact of the program. METHODS: This is a single-center, retrospective, matched, observational cohort study comparing outcomes of hearts transplanted from DCD donors from March 1, 2015 to February 29, 2020 with those from matched donation after brain death (DBD) donors at Royal Papworth Hospital (RPH) (Cambridge, UK). DCD hearts were either retrieved using thoracoabdominal normothermic regional perfusion or the direct procurement and perfusion technique. All DBD hearts were procured using standard cold static storage. The primary outcomes were recipient 30-day and 1-year survival. RESULTS: During the 5-year study, DCD heart donation increased overall heart transplant activity by 48% (79 for DCD and 164 for DBD). There was no difference in survival at 30 days (97% for DCD vs 99% for DBD, p = 1.00) or 1 year (91% for DCD vs 89% for DBD, p = 0.72). There was no difference in the length of stay in the intensive care unit (7 for DCD vs 6 for DBD days, p = 0.24) or in the hospital (24 for DCD vs 25 for DBD days, p = 0.84). CONCLUSIONS: DCD heart donation increased overall heart transplant activity at RPH by 48%, with no difference in 30-day or 1-year survival in comparison with conventional DBD heart transplantations.

The article reviews cannulation strategy for different modes of extracorporeal life support. Technical aspects, pitfalls and complications are discussed for central and peripheral extracorporeal membrane oxygenation (VA, VV, VAV, VVA), biventricular assist device support and extracorporeal CO 2 removal.

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Early donor management delivered by the cardiothoracic retrieval team significantly increased the donor heart utilization rate from existing donors. Moreover, the time in the operating theatre from donor heart arrival to skin incision was significantly reduced.

The treatment of choice for patients with chronic thromboembolic pulmonary hypertension is pulmonary endarterectomy to reduce pulmonary vascular resistance with significant symptomatic and prognostic benefit. The fundamental aim of the surgery is to perform a full endarterectomy (not embolectomy or thrombectomy) in both pulmonary arteries. The operation is performed via a median sternotomy with hypothermic cardiopulmonary bypass (CPB) at 20 °C. Pulmonary arteriotomies are performed within the pericardium and periods of circulatory arrest are necessary to reduce collateral blood flow from bronchial arteries and allow a clear field for dissection distally. The endarterectomy plane is raised carefully as it is essential the correct layer be identified. The dissection proceeds within the superficial media into all the affected segmental and sub-segmental vessels. A cast of the inner layer of the pulmonary arterial tree is then dissected free by eversion moving towards the periphery. After completion of the endarterectomies, and the patient is rewarmed slowly on full CPB. During weaning from CPB the right-sided filling pressures should be kept low, guided by invasive haemodynamic monitoring. Survival to hospital discharge is ≫95% in experienced centres with outcome dependent on the disease pattern and pulmonary vascular resistance pre- and post-surgery.

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A clinical case of successful procurement and transplantation of bilateral lungs from 6‐week‐old infant with sepsis secondary to bacterial meningitis is reported. Forty‐one‐day‐old male infant (height 60 cm, weight 4 kg) died of cerebral edema secondary to Escherichia coli meningitis and bacteremia. Preretrieval assessment included the following: arterial gases; pO2 50.4 kPa (378 mm Hg), pCO2 4.9 kPa (37 mm Hg), on FiO2 100%, PEEP 5 cm H2O. Fiberoptic bronchoscopy showed no secretions nor mucosal inflammation; CXR revealed clear lung fields and pleural spaces. Inspection revealed dense adhesions in pericardial cavity and purulent left hemithorax effusion (urgent Gram‐stain came back as negative) but there was no consolidation in the lung. Good compliance of the lungs on inflation/deflation test was observed. The lungs were retrieved using the technique described. The recipient was a 4‐month‐old infant with alveolar capillary dysplasia and malaligned pulmonary veins. Implantation of the lungs was performed via bilateral thoracosternotomy on cardiopulmonary bypass, cooling to 30°C. Elective support with nitric oxide was used postoperatively. Two years after the transplantation, the recipient doing well with normal lung function. Lung procurement from a 6‐week donor with infectious complications and prolonged ventilation is a challenging undertaking but can be successful and should be attempted whenever possible given the paucity of organs available for pediatric recipients.