Advances in cardiac machine perfusion: Exceeding 8 hours from procurement to implant without requiring extracorporeal membrane oxygenation

Prolonged donor ischemic time (DIT) is a well-documented limitation to carrying out heart transplantation. Most centers accept a DIT of <4 hours in cold static storage, with concerns that exceeding this time may result in primary graft dysfunction. 1 Kobashigawa J. Zuckermann A. Macdonald P. et al. Report from a consensus conference on primary graft dysfunction after cardiac transplantation. J Heart Lung Transplant. 2014; 33: 327-340https://doi.org/10.1016/j.healun.2014.02.027 Abstract Full Text Full Text PDF PubMed Scopus (427) Google Scholar Cardiac machine perfusion is an emerging technology to improve organ preservation in transit. 2 Qin G. Jernryd V. Sjöberg T. Steen S. Nilsson J. Machine perfusion for human heart preservation: a systematic review. Transpl Int. 2022; 3510258https://doi.org/10.3389/ti.2022.10258 Crossref PubMed Scopus (14) Google Scholar There are reports of hearts preserved using the Transmedics Organ Care System withstanding periods of 10 hours 3 Stamp N.L. Shah A. Vincent V. et al. Successful heart transplant after ten hours out-of-body time using the transmedics organ care system. Heart Lung Circ. 2015; 24: 611-613https://doi.org/10.1016/j.hlc.2015.01.005 Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar and 16 hours. 4 Kaliyev R. Bekbossynov S. Nurmykhametova Z. Sixteen-hour ex vivo donor heart perfusion during long-distance transportation for heart transplantation. Artif Organs. 2019; 43: 319-320https://doi.org/10.1111/aor.13359 Crossref PubMed Scopus (11) Google Scholar However, in these case reports, the hearts required extracorporeal membrane oxygenation (ECMO) postoperatively, suggesting early graft dysfunction.