The Journal of Thoracic and Cardiovascular Surgery ( IF 4.9 ) Pub Date : 2021-09-14 , DOI: 10.1016/j.jtcvs.2021.07.059 Deane E Smith 1 , Zachary N Kon 2 , Julius A Carillo 1 , Stacey Chen 1 , Claudia G Gidea 3 , Greta L Piper 4 , Alex Reyentovich 3 , Robert A Montgomery 5 , Aubrey C Galloway 1 , Nader Moazami 1
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Objective
This pilot study sought to evaluate the feasibility of our donation after circulatory death (DCD) heart transplantation protocol using cardiopulmonary bypass (CPB) for normothermic regional reperfusion (NRP).
Methods
Suitable local DCD candidates were transferred to our institution. Life support was withdrawn in the operating room (OR). On declaration of circulatory death, sternotomy was performed, and the aortic arch vessels were ligated. CPB was initiated with left ventricular venting. The heart was reperfused, with correction of any metabolic abnormalities. CPB was weaned, and cardiac function was assessed at 30-minute intervals. If accepted, the heart was procured with cold preservation and transplanted into recipients in a nearby OR.
Results
Between January 2020 and January 2021, a total of 8 DCD heart transplants were performed: 6 isolated hearts, 1 heart-lung, and 1 combined heart and kidney. All donor hearts were successfully resuscitated and weaned from CPB without inotropic support. Average lactate and potassium levels decreased from 9.39 ± 1.47 mmol/L to 7.20 ± 0.13 mmol/L and 7.49 ± 1.32 mmol/L to 4.36 ± 0.67 mmol/L, respectively. Post-transplantation, the heart-lung transplant recipient required venoarterial extracorporeal membrane oxygenation for primary lung graft dysfunction but was decannulated on postoperative day 3 and recovered uneventfully. All other recipients required minimal inotropic support without mechanical circulatory support. Survival was 100% with a median follow-up of 304 days (interquartile range, 105-371 days).
Conclusions
DCD heart transplantation outcomes have been excellent. Our DCD protocol is adoptable for more widespread use and will increase donor heart availability in the United States.
中文翻译：
美国常温局部灌注循环死亡心脏移植术后捐献的早期经验
客观的
这项试点研究旨在评估我们使用体外循环 (CPB) 进行常温区域再灌注 (NRP) 的循环死亡 (DCD) 心脏移植方案捐赠的可行性。
方法
合适的本地 DCD 候选人被转移到我们的机构。在手术室 (OR) 撤消了生命支持。在宣布循环死亡时，进行胸骨切开术，结扎主动脉弓血管。CPB 以左心室通气开始。心脏再灌注，纠正任何代谢异常。停用 CPB，并以 30 分钟间隔评估心脏功能。如果被接受，心脏将被冷冻保存并移植到附近手术室的接受者体内。
结果
2020 年 1 月至 2021 年 1 月期间，共进行了 8 例 DCD 心脏移植：6 例离体心脏、1 例心肺和 1 例心肾联合。在没有正性肌力支持的情况下，所有供体心脏均成功复苏并从 CPB 断奶。平均乳酸和钾水平分别从 9.39 ± 1.47 mmol/L 下降到 7.20 ± 0.13 mmol/L 和 7.49 ± 1.32 mmol/L 到 4.36 ± 0.67 mmol/L。移植后，心肺移植受者需要静脉动脉体外膜肺氧合治疗原发性肺移植功能障碍，但在术后第 3 天拔管并顺利恢复。所有其他接受者都需要最少的正性肌力支持，无需机械循环支持。生存率为 100%，中位随访时间为 304 天（四分位距，105-371 天）。
结论
DCD 心脏移植结果非常好。我们的 DCD 协议可用于更广泛的使用，并将增加美国的供体心脏可用性。
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