40. Out of the Ice Age: Preservation of Cardiac Allografts with a Reusable 10°C Cooler

Objective: Static cold storage with ice at 0-4°C has been the mainstay of cardiac donor preservation. There has been renewed interest in preservation temperature, and early preclinical data suggests that organ storage at 10°C may be beneficial. We tested this hypothesis by using a static hypothermic storage device initially designed for lung preservation to preserve and transport cardiac allografts.
Methods: 15 cardiac allografts were recovered according to our standard brain death and normothermic regional perfusion (donation after circulatory death) protocols between July 2023 and October 2023 and transported using commercially available static storage cooler designed to sustain ambient temperature at 10°C. Results were compared to a 3:1 historical control cohort (10/2022-7/2023). Patients were excluded for the following: combined heart liver transplant, previous heart transplant, congenital heart disease, or allograft injury on recovery.
Results: Among the 10°C cohort, the mean preservation temperature was 8.87°C. The mean preservation time was 218 +/- 113 min in the 10°C cohort vs 210 +/- 72 min in the ice cohort (p=0.85). Forty percent (N=6) of the 10°C group had ischemic times > 240 minutes, compared to thirty-three percent (N=15) in the ice group (p= 0.75). Donor hearts in the 10°C group showed a trend towards lower peak post-operative lactate level (7.7 v 11.5, p=0.07). There was no difference in inotrope scores at 72 hours (p=0.6). There was a significantly shorter hospital LOS in the 10°C group (13+/- 5 days vs 19 +/- 19 days p= 0.005). There was a strong, non-significant, trend towards less severe PGD requiring ECMO in the 10°C group (0% vs 13.3%, p=0.32). Within the 10°C cohort, there was no difference in performance of the allografts with >240 min ischemic times vs < 240 min ischemic times regarding lactate, cardiac index, and inotropes scores at ICU arrival and 24 hours (Figure 1).
Conclusions: This is the first-in-human experience of static heart preservation with a reusable 10°C cooler. Postoperative allograft function was excellent, notably among those with extended ischemic times. Static preservation using this device is safe and may offer an inexpensive platform for extended heart preservation in both DBD and DCD donors. This study is limited by sample size, and further investigation is needed to assess the potential benefits of 10°C storage.

John Trahanas (1), Chetan Pasrija (1), Stephen DeVries (1), Swaroop Bommareddi (1), Timothy Harris (1), Anthony Dreher (1), Mark Petrovic (1), Alexandra Debose-Scarlett (1), Hasan Siddiqi (1), Avery Fortier (1), Kaitlyn Tracy (1), clifton keck (1), Michael Cortelli (1), Shelley Scholl (1), Matthew Bacchetta (1), Ashish Shah (1), (1) Vanderbilt University Medical Center, Nashville, TN

Friedhelm Beyersdorf

Commentator

Friedhelm Beyersdorf, born in 1954 went to Medical School from 1975 - 1981 in Frankfurt/M., Germany and included clinical clerkships at the Johns Hopkins University Baltimore and the Thomas Jefferson Medical College, Phildelphia. He passed the German and US Boards Part I and II and got `summa cum laude´ for his doctoral thesis in 1981. He accomplished is postgraduate training in Thoracic and Cardiovascular Surgery in Frankfurt and his Research Training from 1984-1985 at the Department of Cardio-Thoracic Surgery at the University of California, Los Angeles with Dr. Gerald D. Buckberg. He passed the Boards of General, Cardiothoracic and Vascular Surgery.

He was appointed full Professor of Cardiovascular Surgery at the Albert-Ludwigs-University Freiburg in 1994 and served as the Chairman of the Department from 1994 - 2022. He developed his Department into one of the most busiest ones in Germany with finally 8 ORs and 4,500 cardiac and vascular cases/year, including the full spectrum of pediatric and adult cardiovascular surgery, heart, heart-lung and lung transplantations, mechanical circulatory assist devices and total artificial hearts, and a very busy aortic program. He received the title as Professor honoris causa in 2000 and Doctor honoris causa in 2008 and founded the Charity Organisation `Kinderherzen retten e.V.`(Save the Children´s Hearts) in 2002 and the Start-up Company `Resuscitec `from the University in Freiburg in 2010.

He served as the President of the German Society for Thoracic and Cardiovascular Surgery (DGTHG) from 2009 - 2011, as the Editor-in-Chief of the European Journal of Cardio-Thoracic Surgery (EJCTS) and the Interactive  Cardiovascular and Thoracic Surgery (ICVTS) from 2010 - 2020 and as the President of the European Association for Cardio-Thoracic Surgery (EACTS) from 2021 - 2022. He received numerous national and international awards.

 

 

 

John Trahanas

Abstract Presenter

Dr. John Trahanas is an Assistant Professor of Cardiac Surgery at Vanderbilt University Medical Center. Prior to Vanderbilt Dr. Trahanas completed his cardiac surgery training at the Massachusetts General Hopsital with advanced training at Duke University Medical Center. He cares for the full spectrum of patients with adult cardiac disease, aortic disease as well as advanced heart failure. His reasearch interestes include heart preservation, heart tranplantation, with specific expertise in DCD heart recovery and transplantation. Along with the other surgeons at Vanderbilt, Dr. Trahanas has helped to standardize normothermic regional perfusion for the recovery of DCD heart donors.