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Published on: November 28, 2025
Hypothermic Circulatory Arrest in Cardiac Transplantation
B Lima1, T Chamogeorgakis1, J C MacHannaford1
1Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, Texas.
Insights
Hypothermic circulatory arrest (HCA) is rarely needed for complex heart transplants. This study shows patients undergoing HCA for cardiac transplantation can survive, though they face longer hospital stays and potential complications.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Transplantation Medicine
Background:
- Hypothermic circulatory arrest (HCA) is infrequently required for complex cardiac transplantation.
- Indications include aortic arch surgery, ventricular assist device explantation, and dense mediastinal adhesions.
- Outcomes of heart transplantation with HCA are not well-documented.
Purpose of the Study:
- To catalog outcomes of heart transplantations performed using HCA.
- To evaluate the safety and efficacy of HCA in complex cardiac transplant cases.
Main Methods:
- A retrospective analysis of 7 heart transplant patients who required HCA between November 2012 and December 2014.
- Data were collected from a prospectively maintained clinical database.
- Postoperative outcomes were analyzed.
Main Results:
- The 7 patients (3.6% of total transplants) had a mean age of 46, with 71% having nonischemic cardiomyopathies.
- Most patients (71%) had prior ventricular assist device implantation; one had complex congenital heart disease repair.
- Mean HCA and cold ischemic times were 25 and 285 minutes, respectively. Hospital survival was 86%, with a mean length of stay of 31 days. Postoperative complications included renal failure (43%), respiratory failure (43%), and stroke (29%).
Conclusions:
- HCA can be safely instituted for complex cardiac transplantation in select cases.
- Patients undergoing HCA for heart transplantation can achieve hospital discharge.
- These patients may experience prolonged hospital stays and moderate rates of end-organ complications.
Purpose:
Infrequently, hypothermic circulatory arrest (HCA) must be used during cardiac transplantation. Such cases may include concomitant aortic arch surgery, explantation of ventricular assist devices with outflow grafts or pseudoaneurysms closely abutting the sternum, and other scenarios for which dense mediastinal adhesions preclude exposure and anatomic dissection by conventional methods of adhesiolysis. Outcomes of heart transplantations performed with HCA have not been previously catalogued in the literature and are presented in the current case series.
Methods:
Between November 2012 and December 2014, 193 patients underwent heart transplantation at a single institution. Of these, 7 cases (3.6%) required implementation of HCA. Postoperative outcomes in these patients were analyzed using a prospectively maintained clinical database.
Results:
The HCA patients included 28% females, with mean age of 46 years, and 71% had nonischemic cardiomyopathies. The majority (N = 5, 71%) had prior ventricular assist device implantation, including 1 patient with a paracorporeal biventricular assist device. One of the remaining 2 patients had three previous surgeries for repair of tetralogy of Fallot, with a completely calcified right ventricular outflow tract and pulmonary arterial system. Mean HCA and cold ischemic times were 25 minutes (range, 9-34 minutes) and 285 minutes (range, 181-425 minutes), respectively. Mean postoperative length of stay was 31 days, and six of seven patients (86%) survived to hospital discharge. One patient expired as an outpatient 2 months following transplant. Rates of postoperative renal failure, respiratory failure, and stroke were 43%, 43%, and 29%, respectively.
Conclusion:
On rare occasions, HCA must be instituted to safely conduct a complex heart transplantation procedure. Based on this small case series, these patients can be salvaged and discharged from the hospital, but may experience prolonged lengths of stay with moderate rates of other end-organ complications.
