Heart transplant outcomes in patients with mechanical circulatory support: cold storage versus normothermic perfusion organ preservation

OBJECTIVES: Patients with mechanical circulatory support bridged to a heart transplant (HTx) are at higher risk of postoperative graft dysfunction. In this subset, a mode of graft preservation that shortens graft ischaemia should be beneficial.METHODS: The outcomes of 38 patients on mechanical circulatory support (extracorporeal life support, left ventricular assist device and biventricular assist device) who received a HTx between 2015 and 2020 were analysed according to the method of graft preservation: cold storage (CS) group, 24 (63%) or ex vivo perfusion (EVP) group, 14 (37%).RESULTS: The median age was 57 (range 30-73) vs 64 (35-75) years (P=0.10); 88% were men (P=0.28); extracorporeal life support was more frequent in the CS group (54% vs 36%; P=0.27) versus left ventricular and biventricular assist devices in the EVP group (46% vs 64%; P=0.27). Clamping time was shorter in the EVP group (P<0.001) and ischaemic time >4h was higher in the CS group (P=0.01). Thirty-day mortality was 13% (0-27%) in the CS group and 0% (P=0.28) in the EVP group. A significantly lower primary graft failure [7% (0-23%) vs 42% (20-63%); P=0.03] was observed in the EVP group. Survival at 1year was 79±8% (63-95%) in the CS group and 84±10% (64-104%) in the EVP group (P=0.95).CONCLUSIONS: Our results support the use of ex vivo graft perfusion in patients on mechanical circulatory support as a bridge to a HTx. This technique, by shortening graft ischaemic time, seems to improve post-HTx outcomes.