Chest Wall, Thymus, and Heart Transplant: Pushing the Boundary of Solid Organ and Vascularized Composite Allotransplantation

Background: The purpose of this study is to design a proof-of-concept cadaveric model to describe technical aspects of allograft harvest and recipient inset of an en bloc chest wall, thymus, and heart transplant. Materials and Methods: Two surgical simulations were performed involving procurement and inset. Four cadavers were obtained and identified as donor or recipient. Debriefing following each simulation addressed technical feasibility, anatomical considerations, degree of difficulty, length of surgery, and formulating a bailout strategy. An intraoperative vascular dye perfusion study was performed to determine the vascular territories of the chest wall and the need for bilateral arterial inflow to the chest. Results: Both transplant procedures were successfully completed. Mean donor age was 88.5 y old (range: 83–94). Allograft harvest mean duration was 94.5 minutes (range: 89–100). Graft inset duration was 90.5 minutes (range: 88–93), with a mean duration of 33 minutes (range: 25–41) of chest wall fixation. The right and left IMA, each demonstrated ipsilateral colored staining of the chest wall, without evidence of dye crossing midline. Strong skin and muscle staining was observed with moderate staining of bone. Conclusion: This cadaveric surgical simulation supports the en bloc chest wall, thymus, and heart transplant to be technically feasible for clinical application.