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Heterotopic abdominal heart transplantation: a pilot study
David J Caparrelli1, Jay G Shake, Stephen M Cattaneo
1Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD 21287, USA.
Insights
A new heterotopic abdominal heart transplant (HAHT) model shows promise for using marginal donor hearts. This innovative approach could expand the donor pool for cardiac transplantation, addressing the critical organ shortage.
Area of Science:
- Cardiovascular Surgery
- Transplantation Immunology
- Organ Preservation
Background:
- Critical shortage of donor hearts for cardiac transplantation.
- Increased utilization of marginal donor organs, yet demand persists.
- Limitations in current marginal donor organ use due to immediate circulatory support requirements.
Purpose of the Study:
- Investigate heterotopic abdominal heart transplant (HAHT) as a strategy to expand the donor heart pool.
- Assess the technical feasibility of HAHT.
- Evaluate HAHT's potential as auxiliary circulatory support for low cardiac output.
Main Methods:
- Development of a novel heterotopic abdominal heart transplant (HAHT) model.
- Pilot study to investigate hemodynamic and metabolic consequences.
- Proof-of-concept investigation.
Main Results:
- Demonstrated technical feasibility of HAHT.
- Provided evidence for HAHT's potential as auxiliary circulatory support.
- Characterized hemodynamic and metabolic effects in a pilot study.
Conclusions:
- HAHT is a technically feasible strategy.
- HAHT offers potential for auxiliary circulatory support in low cardiac output scenarios.
- This pilot study provides a foundation for future research into expanding donor organ utilization.
Abstract:
The increasingly severe shortage of donor hearts has prompted a liberalization of what is considered an acceptable donor heart. The use of marginally acceptable organs has increased in recent years. Although these marginal donors have proved effective, there still remains a tremendous shortage of donors to treat the large number of patients who are candidates for cardiac transplantation. Further use of marginal donors is limited by the requirement to assume immediate and full support of the circulation. New strategies are required to increase donor organ use even further. The authors developed a model of heterotopic abdominal heart transplant (HAHT) to investigate the possibility of using marginal donor hearts to expand the donor pool for cardiac transplantation. The authors' goal was to show that HAHT was technically feasible and could potentially function as auxiliary circulatory support in the setting of low cardiac output. The hemodynamic and metabolic consequences of a HAHT were investigated in a pilot study that provides proof of concept and lays the groundwork for future investigations.