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Updated: Aug 23, 2026
A Pre-Clinical Porcine Model of Orthotopic Heart Transplantation
Published on: April 27, 2019
Concomitant donor heart coronary artery bypass grafting during orthotopic heart transplantation
C M Burnett1, B Radovancević, S Birovljev
1The Section of Cardiac Transplantation, Division of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas 77225-0345, USA.
Insights
A critical heart transplant recipient received a donor heart with coronary artery stenosis. An innovative bypass procedure using the recipient
Area of Science:
- Cardiology
- Transplant Surgery
- Vascular Surgery
Background:
- Severe cardiomyopathy poses a significant challenge for heart transplant candidates.
- Donor organ shortages necessitate expanded donor selection criteria.
- Coronary artery stenosis in donor hearts can be a contraindication for transplantation.
Purpose of the Study:
- To describe an innovative surgical technique for heart transplantation using a donor heart with coronary artery stenosis.
- To evaluate the early outcomes of this procedure in a critically ill patient.
Main Methods:
- Standard orthotopic heart transplantation was performed.
- Coronary arteriography identified stenosis in the donor heart's left anterior descending artery.
- The recipient's internal mammary artery was used to bypass the stenosis in the donor heart's coronary artery.
Main Results:
- The patient's postoperative course was relatively complication-free.
- The cardiac allograft demonstrated good function.
- Early results are comparable to historical heart transplant control groups.
Conclusions:
- Innovative surgical techniques can expand donor heart utilization.
- Extended donor selection criteria, including managing coronary stenosis, may alleviate organ shortages.
- This approach offers a viable option for critically ill patients awaiting heart transplantation.
Abstract:
A 54-year-old diabetic woman with severe cardiomyopathy was placed on our heart transplant candidate list. The patient's condition rapidly worsened and a potential donor-a 45-year-old man whose blood was compatible with that of our patient-was located. Because of the donor's age, coronary arteriography was done, and stenosis in the midleft anterior descending coronary artery was identified. Since the patient's status was critical, the donor heart was accepted despite the presence of stenosis. We used the recipient's internal mammary artery to bypass the stenosis in the left anterior descending artery of the donor heart after performing a standard orthotopic heart transplant. The patient's postoperative course has been relatively free of complications, and the cardiac allograft has functioned well. The early results in this patient are comparable to those of our historical transplant control group. We suggest that the impact of donor organ shortages may be lessened by use of innovative procedures and extended donor selection criteria.
