[New frontiers in myocardial preservation]

The high hospital mortality due to primary graft failure, together with the ever more frequent use of "Suboptimum" donors because of the scarcity of organs has, in the recent years, caused renewed interest in perfectioning techniques of cardiac preservation. The numerous studies supporting the benefits of a period of controlled warm reperfusion after global ischemia, and the growth of the continuous warm blood cardioplegia, led us to the evolution of our own technique for myocardial protection during transplantation. Dr John Wallwork introduced the concept of donor "resuscitation" in the attempt to improve the hemodynamic state of the donor, by preload and afterload manipulation and pharmacological treatment of the unstable or "marginal" donor. The Juan Canalejo Hospital introduced the concept "Resuscitation during the implantation" using continuous warm blood cardioplegia. Maintenance of normothermia during heart transplantation produces what is referred to as "cell repair" or "resuscitation during the implantation" and avoid the reperfusion damage. From january 1992 to april 1995, 91 orthotopic heart transplantation were performed at our institution. By harvesting we have employed the conventional preservation technique. We performed a controlled continuous anterograde/retrograde warm blood cardioplegic reperfusion of the graft, before and during the implantation in 53 patients. Since january 1994 we performed in 38 cases the same controlled continuous warm blood reperfusion, but only anterograde. Continuous warm blood cardioplegia in heart transplantation is a safety myocardial protection method. Trasplant programs require the optimal use of the available donors.