Near-zero Ischemia After Prolonged Warm Ischemic Time: Beating-heart DCD Heart Transplantation Following Thoracoabdominal Normothermic Regional Perfusion
Matteo Marro, Erika Simonato, Antonio Loforte, Michele William La Torre, Marinella Zanierato, Mauro Rinaldi, Massimo BoffiniBackground.
Heart transplantation is limited by donor organ shortage and ischemia-reperfusion injury, particularly in donation after circulatory death (DCD). Thoracoabdominal normothermic regional perfusion (TANRP) enables in situ myocardial resuscitation and assessment, while beating-heart strategies further reduce ischemic exposure.
Methods.
We report a DCD heart transplantation performed using in situ TANRP followed by beating-heart procurement, short-distance transfer without coronary flow, and implantation under continuous normothermic blood perfusion using the recipient cardiopulmonary bypass circuit.
Results.
Graft ischemic time was near zero. Immediate graft function was achieved, and no early postoperative complications were observed.
Conclusions.
This case supports the technical feasibility of an almost fully ischemia-sparing, beating-heart transplantation strategy after TANRP in DCD donation. Further experience is required to assess reproducibility, safety, and clinical impact.