Successful aortic arch cannulation and perfusion of a heart donated after circulatory death: A case report
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Updated: Jul 17, 2025
Large-Animal Model of Donation after Circulatory Death and Normothermic Regional Perfusion for Cardiac Assessment
Published on: May 10, 2022
Mats T Vervoorn1, Paul van Kaam2, Mostafa M Mokhles1
1Department of Cardiothoracic Surgery, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands.
Insights
Aortic arch cannulation is a feasible method for perfusing hearts from donors after circulatory death (DCD), even in complex cases with altered anatomy. This technique ensures satisfactory organ quality for transplantation.
Area of Science:
- Cardiovascular Surgery
- Organ Transplantation
- Cardiopulmonary Bypass
Background:
- The use of donor hearts after circulatory death (DCD) is expanding.
- Complex congenital heart disease can necessitate altered aortic anatomy for transplantation.
- Standard perfusion protocols may not be suitable for all DCD donor hearts.
Observation:
- A 47-year-old male recipient with prior Mustard operation required an elongated aorta for heart transplantation.
- A donor heart was successfully perfused for 4.5 hours using aortic arch cannulation with the Transmedics Organ Care System™.
- Perfusion parameters were satisfactory despite concerns about malperfusion with this technique.
Findings:
- Aortic arch cannulation is a viable technique for perfusing DCD donor hearts.
- Careful cannulation and positioning can mitigate risks of malperfusion.
- Satisfactory perfusion can be achieved even with anatomically challenging recipients.
Implications:
- This technique expands the donor pool for heart transplantation.
- It offers a solution for recipients with surgically corrected congenital heart disease and altered aortic anatomy.
- Further attention to cannulation technique is crucial for successful DCD heart transplantation.
Introduction:
We describe successful aortic arch cannulation and perfusion of a heart donated after circulatory death using the Transmedics Organ Care System™.
Case Report:
A 47-year old man developed advanced heart failure symptoms after prior mustard operation for transposition of the great arteries. He matched a DCD-donor and required an elongated aorta for implantation due to his altered anatomy. The donor heart was retrieved and successfully perfused via aortic arch cannulation for 4.5 h with satisfactory perfusion parameters.
Disussion:
Although Transmedics advises against aortic arch cannulation due to concerns regarding malperfusion, satisfactory and safe perfusion can be achieved by careful positioning of the heart. Awareness and attention to the occurrence of malperfusion is mandatory, especially during transport, to achieve satisfactory outcome.
Conclusion:
Aortic arch cannulation is feasible without compromising quality of perfusion. This is relevant for patient that require an elongated aorta after surgically corrected congenital heart disease.
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