Donor Heart Preservation: Current Knowledge and the New Era of Machine Perfusion

Area of Science:

• Cardiovascular Surgery
• Organ Transplantation
• Regenerative Medicine

Background:

• Static cold storage (SCS) is the standard for heart donor preservation but risks graft dysfunction due to ischemia and reperfusion injury.
• Increasing demand for marginal grafts necessitates advanced organ preservation and repair strategies.
• Novel preservation techniques are crucial for improving outcomes in heart transplantation.

Purpose of the Study:

• To review current knowledge and novel methods for donor heart preservation.
• To explore the potential of machine perfusion in heart transplantation.
• To highlight emerging pharmacological repair treatments for donor hearts.

Main Methods:

• Review of current literature on heart donor preservation techniques.
• Focus on hypothermic and normothermic machine perfusion.
• Discussion of cardioprotective agents and pharmacological repair strategies.

Main Results:

• Machine perfusion shows potential comparable to cold cardioplegia for donor preservation.
• Machine perfusion allows for graft function assessment and potential repair before implantation.
• Emerging treatments, like triiodothyronine during normothermic perfusion, show favorable effects on cardiac function and microvascular integrity.

Conclusions:

• Machine perfusion is a promising platform for preserving donor hearts, utilizing marginal organs, and increasing the donor pool.
• Pharmacological interventions can optimize machine perfusion, enhancing practicality and cost-effectiveness.
• Novel approaches like triiodothyronine administration during perfusion may mitigate apoptosis and improve graft viability.