Related Experiment Video
Updated: Dec 10, 2025
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Valvular surgery in donor hearts before orthotopic heart transplantation
Antonio Fiore1, Antonino Massimiliano Grande2, Giuseppe Gatti3
1Department of Cardiac and Thoracic Surgery, Henri-Mondor University Hospital, AP-HP, 94000 Créteil, France.
Insights
Utilizing valve repair in donor hearts with valvulopathy can expand the donor pool for heart transplantation. This approach can decrease waiting list mortality for patients needing an orthotopic cardiac transplant.
Area of Science:
- Cardiology
- Transplantation Surgery
- Cardiac Surgery
Background:
- Donor heart shortage leads to prolonged waiting times and increased mortality for transplant candidates.
- Traditionally, donor heart valvulopathy was a contraindication for organ donation, limiting the available donor pool.
- Expanding donor criteria is crucial to address the organ shortage in heart transplantation.
Purpose of the Study:
- To evaluate the outcomes of aortic and mitral valve surgery in marginal donor hearts with valvulopathy prior to orthotopic heart transplantation.
- To determine the feasibility and efficacy of using donor hearts with valvular disease for transplantation.
Main Methods:
- Analysis of 53 heart transplantations performed between January 2012 and November 2015.
- Echocardiography identified valvular disease in four donors: three with mitral regurgitation and one with aortic stenosis.
- Conventional valvular procedures (mitral repair, aortic valve replacement) were performed on these marginal donor hearts.
Main Results:
- Surgical procedures on donor hearts included mitral repair (mean 18 min) and aortic valve replacement (mean 78.7 min cross-clamp time).
- Intraoperative echocardiography confirmed successful valve repair/replacement and good ventricular function.
- One patient experienced a fatal outcome due to pneumonia; however, the remaining patients achieved long-term recovery and returned to an active lifestyle.
Conclusions:
- Conventional surgical techniques for mitral and aortic valve pathology in donor hearts are effective.
- Utilizing these "marginal" donor hearts can significantly expand the donor pool for cardiac transplantation.
- This strategy has the potential to reduce mortality rates among patients awaiting a heart transplant.
Background:
Donor heart shortage has extended the waiting time and increased the mortality of patients on the transplant waiting list. Widening old standard donor criteria has successfully increased the number of heart transplantations, but for many years, a valve disease in a donor heart has been considered a primary contraindication for organ donation.
Aims:
To analyse the results of aortic and mitral valvular surgery in marginal donor hearts with valvulopathy before orthotopic heart transplantation.
Methods:
Between January 2012 and November 2015, we performed 53 heart transplantations in our department. In four donors, echocardiography performed at the time of organ procurement showed a valvular disease: three had moderate-to-severe mitral regurgitation; and one had moderately severe aortic valve stenosis.
Results:
The mean bench mitral repair and aortic replacement time, aortic cross-clamp time and total ischaemic time were: 18 (range 7-25) minutes, 78.7 (range 57-98) minutes and 184 (range 89-255) minutes, respectively. Intraoperative transoesophageal echocardiography showed good mitral repair or aortic prosthetic valve function, and good right and left ventricular function. One patient died of infectious pneumonia after 1 month. The mean duration of follow-up for the patients discharged home was 75±13 months, and all have returned to an active unrestricted lifestyle.
Conclusions:
Our limited series demonstrates that conventional valvular procedures performed on otherwise healthy donor hearts with mitral and aortic valve pathology can efficaciously expand the donor pool for orthotopic cardiac transplantation and decrease the mortality rate on the waiting list.
