(1528) Orthotopic Heart Transplantation Experience Using Marginal Hearts

Introduction: Today there is an acute shortage of heart donors all over the world. At the same time, about 500 patients in need of heart transplantation (HT) in Ukraine. Military actions on the territory of Ukraine only exacerbated this problem. In this regard, we have expanded the criteria for accepting a donor heart. And in our study we analyzed the experience of HT using marginal hearts.

Methods: From February 2022 to July 2023, at the Heart Institute of the Ministry of Health of Ukraine (Kyiv), we performed 39 HT, of which 18 donor hearts (46.2%) were considered to be marginal due to high inotropic support (n = 7), female to male transplantation (n = 6) with donor to recipient body weight ratio 0.71±0.05, old donor age (n = 3), left ventricular hypertrophy (n = 2). In order to reduce ischemic time and due to the closure of the airspace over our country, HT were carried out at the site of heart harvesting with the departure of a mobile transplant team and the recipient.

Results: The age of donors was 46 ± 15 years. All donors (39 patients) received inotropic support: noradrenaline 0.96±0.41 µg/kg/min (39 donors (100%)), dobutamine 5.37±2.37 µg/kg/min (16 donors (41.0 %)), dopamine 3.48±1.49 µg/kg/min (10 donors (25.6%)). 17 donors (43.6%) received combined inotropic support. At the same time, troponin values were recorded in the range from 3.3 to < 200 ng/ml.
Acute graft dysfunction was observed in 8 patients (20.5%) requiring intra-aortic balloon pumping or veno-arterial ECMO. 4 patients (10.3%) died in the perioperative period. At the same time, 2 (5.1%) patients died as a result of acute graft dysfunction, 1 (2.6%) patient developed catecholamine necrosis of the graft, another 1 (2.6%) patient had a significant decrease in graft pumping function without the effect of inotropic support and mechanical support. 6 patients (15.4%) required high doses of adrenomimetics in the early postoperative period.
The logistical method of HT at the donor site made it possible to reduce the graft ischemic time to 95+15 min, which determined the survival of recipients (89.7% of cases), despite the use of marginal hearts.

Conclusions: Careful selection of donors is a key moment in the preparation for a HT. However, long-term survival in recipients with marginal donor hearts may be satisfactory with adequate treatment.