Perioperative period in heart transplantation with extremely prolonged ischemic times (>6 hours)

Amidst the shortage in viable donor hearts, the use of hearts from expanded criteria donors, including those with prolonged ischemic time, remains one of the real ways to increase the donor pool and number of heart transplantations (HTx) performed. The study included 38 recipients (33 (86.8%) men and 5 (13.2%) women) aged 11 to 66 (44.7 ± 12.0 years, median 48.0 years), who underwent primary (n = 37; 97.4%) or repeat (n = 1; 2.6%) HTx (retransplantation). Donor hearts (n = 38) with ischemic time ranged from 362 (6 hours 2 minutes) to 571 (9 hours 31 minutes) or 407 ± 52 minutes (median 400 minutes). In 33 (86.8%) of 38 recipients, the early posttransplant period was characterized by satisfactory initial graft function. Five (13.1%) recipients developed severe primary graft dysfunction, requiring post-transplant venoarterial extracorporeal membrane oxygenation (VA-ECMO) (n = 4; 10.5%) or prolongation of pre-transplant VA-ECMO within 8 days of HTx (n = 1; 2.6%). In-hospital mortality was 7.9% (n = 3). Thirty-five (92.1%) of 38 recipients were discharged from the hospital. Three recipients died in the post-hospital period at day 734, 944, and 2146 after HTx. Thirty-two (84.2%) of the 38 recipients remained alive at the end of the study. Our own experience shows that HTx from donors with prolonged ischemic time could be effective.