Controlled temperatures in cold preservation provides safe heart transplantation results

Abstract

Background We aimed to investigate the short‐term outcomes of heart transplant patients who underwent SherpaPak™ donor organ preservation. Method We prospectively collected the data of patients who underwent heart transplantation using SherpaPak™ system for donor organ transportation from February 2020 to March 2021. Donor and recipient demographic data, preoperative and postoperative echocardiographic and hemodynamic parameters, total ischemic time and SherpaPak temperatures, vasoactive inotropic scores (VIS), primary graft dysfunction (PGD) status, intensive care unit stay, complications, and mortality during follow‐up were assessed. Results A total of 39 consecutive heart transplant patients with SherpaPak system were included in the study. The mean donor age was 32.2 ± 6.7 (range: 16–46). The mean recipient age was 57.5 ± 12 (range: 19–73). The mean preoperative ejection fraction (EF) was 23.7 ± 15.4 (range: 5–75). All recipients underwent a standard bicaval technique for orthotopic heart implantation. The mean total ischemic time was 230.1 ± 41 (range: 149–342) min. The mean Sherpa temperature was 5.6 ± 0.8°C (range: 3.7–7.5). The mean VIS was 10.2 ± 6.5 (range: 2–32). The number of mild PGD was 5 (14.7%), and moderate PGD was 4 (11.8%). There was no severe PGD. The postoperative EF was 64.3 ± 5.5 (range: 50–78). Mean intubation time was 47.4 ± 64 (range: 8–312, median: 22) h. The mean time of intensive care unit stay was 6.3 ± 5 (range: 2–31, median: 5) days. Two patients required chest revision (5.8%), two patients had lung infection (5.8%). Two patients had a stroke (5.8%). There was no mortality. Conclusion Using the SherpaPak system during heart transplantation is safe and not associated with significant recipient morbidity. None of the recipients experienced significant PGD and mortality.

Outcomes of Heart Transplantation Using a Temperature-controlled Hypothermic Storage System

“…24 The total allograft ischemic time using the SherpaPak in this study was significantly longer than what was previously reported. 15-17 This is an important finding, which could potentially support our expanding practice by accepting donor organs from a more geographically remote location. Although the SherpaPak system is more expensive than SCS, with a total estimated cost of $16 000, the preparation time is shorter; the management is straightforward; and it is still cheaper than other preservation systems, such as the TransMedics Organ Care System.…”

“…The Food and Drug Administration–cleared SherpaPak Cardiac Transport System (Paragonix Technologies, Braintree, MA) is a novel technology that provides stable, optimal hypothermic control during organ transport. 15-17 It has been hypothesized that this improvement in organ preservation condition during transport has the potential to impact organ quality and consequently patient outcomes while allowing surgeons to accept donor organs from significantly more remote geographic locations. The objectives of this study were to describe our experience with this temperature-controlled hypothermic storage system and to compare early outcomes after heart transplantation after using this novel technology versus SCS method for organ preservation and transportation.…”

A theory of relativity in donor organ ischemia

“…Beyond the obvious priority for cannulating within the warm ischemia limits of a DCD, there are often simple and straightforward opportunities for shaving off minutes of ischemic time such as an expedited departure from the donor hospital, meticulous coordination with the air and ground transport teams, and selection of the optimal transport strategy. Operational efficiency in transporting the donor, although often overlooked, represents the primary focus of a growing number of ventures which were recently formed to address this problem 11–14 . Perhaps with the regulatory approval of drone delivery, surgeons will once again enjoy the benefits of performing the pulmonary arterial anastomosis on an arrested heart.…”

“…Operational efficiency in transporting the donor, although often overlooked, represents the primary focus of a growing number of ventures which were recently formed to address this problem. [11][12][13][14] Perhaps with the regulatory approval of drone delivery, surgeons will once again enjoy the benefits of performing the pulmonary arterial anastomosis on an arrested heart.…”

Better Than Ice: Advancing the Technology of Donor Heart Storage With the Paragonix SherpaPak

“…Retrospective single-center experiences with Sherpapak technology have been reported by a small number of centers in recent years. [13][14][15][16][17] Early results from the GUARDIAN Registry were presented at the 2022 annual meeting of the International Society of Heart and Lung Transplantation. 18 At that time, the registry included data from 11 participating heart transplant centers in the United States, with a cohort of 156 patients receiving organs preserved with conventional cold storage (control), and 227 receiving organs preserved with the SherpaPak.…”