Preservation by cold storage vs ex vivo normothermic perfusion of marginal donor hearts: clinical, histopathologic, and ultrastructural features

A Case of Dramatic Sarcomere Disarray in a Marginal Donor Heart Explanted Soon After Cardiac Arrest: Possible Rearrangement After Ex Vivo Perfusion

“…Although no comparable sarcomere disarray was observed in explanted hearts then subjected to standard cold cardioplegia, it is conceivable that a possible reconditioning may be more likely to occur after reperfusion in vivo, since cold storage was found not to allow restoration of mild postmortem sarcomere changes. 3 Taking into account that in the present case cardiomyocytes from the T 2 -biopsy also showed normal features despite the posttransplant ischemia-reperfusion, ex vivo preservation seems to have mitigated the tissue damage that is expected after long ischemic times. Indeed, ultrastructural patterns of cardiomyocyte degeneration following graft reperfusion in vivo were observed much more frequently in borderline hearts subjected to cold storage.…”

Cardiac Surgery in Advanced Heart Failure

“…A total of 21/26 marginal donor hearts preserved by OCS TM were successfully transplanted with 5/26 donor hearts discarded because considered unsuitable while on the OCS TM . These 21 patients presented an overall lower burden of postoperative complications when compared to control-group marginal donor hearts preserved by cold storage [105]. Altogether, the results from the latter studies suggest that ex vivo normothermic perfusion permits appraisal of marginal donor heart function and has the potential to exclude non-suitable marginal donor grafts from transplantation.…”

“…In Switzerland, only 27.5% of all donor heart offers (n = 199/723) were transplanted in the years 2007-2013, and the mean age was 40.2 years [110], suggesting that application of extended criteria may expand the donor heart pool only by considering older-age donor hearts for transplantation. In addition, the results from the extended-criteria donor hearts evaluated by the OCS TM indicate that expansion of the donor heart pool beyond older age and by inclusion of donor heart with structural pathology is possible [105]. The 10 year update of the listing criteria for HTx recommends that advanced HF patients can be considered for HTx if they are < 71 years of age, while HTx remains an option in selected patients > 70 years [108].…”

Ex vivo donor heart preservation in heart transplantation

“…The longest successful "out of body" time in our experience was of 9 h even if capillary hemorrhage and cardiomyocyte degeneration are soon evident after 6 h of support as showed by myocardial biopsies performed before implantation. 3 For this reason, we do not recommend OCS perfusion longer than 8 h.…”