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OC77 THE OCS HEART SYSTEM FOR EX-VIVO PERFUSION OF THE DONOR HEART

THE NIGUARDA EXPERIENCE

Botta, L.1; Cannata, A.1; Merlanti, B.1; Costetti, A.1; Tata, G.1; Marchetti, C.1; Bosi, M.1; Russo, C.F.1

Journal of Cardiovascular Medicine: November 2018 - Volume 19 - Issue - p e29
doi: 10.2459/01.JCM.0000549924.39078.10
9. ORAL PRESENTATION - HEART FAILURE SATURDAY 24 - 17.15-19.15: PDF Only
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Background: The “Organ Care System (OCS)- Heart”-TransMedics (TM) is the only clinical platform for ex-vivo perfusion of human donor hearts, preserving the graft in a warm beating state. AIM: To analyze results of HTX performed with OCS.

Methods: From 2015 to 2018, 7 patients (mean age: 46y) received a donor heart (mean age: 39y) preserved with the OCS-Heart system. Ischemic, cardiopulmonary (CPB) bypass time and day-0/day-1 CK-MB levels (TM-group) were compared with those of 95 patients transplanted with the cold static storage (CSS-group). The OCS was used for expected long ischemic times or for adverse donor (cardiac arrest) or recipient (infected LVAD, ECMO and unusual anatomy) features.

Results: Mean out-of-the-body perfusion time was 296 minutes. Overall ischemic time was 124 (TM-group) vs. 187 minutes in the CSS-group (P = 0.01). The OCS allowed to spare 159 minutes of estimated ischemia. D0/D1 CK-MB was 115 and 36 vs. 125 and 47 ng/ml in the CSS-group (P = NS). ICU stay was 20 days. Two patients died for hemorragic shock (LVAD recipient) and for multiorgan failure. One patient developed a severe right failure, treated by mechanical assistance, weaned after 8 days. Five recipients are alive at a mean FU of 18 months.

Conclusions: Ex-vivo perfusion of donor hearts is technically safe and permits a significant reduction of the ischemic time. A trend toward reduction of myocardial damage was observed when compared to CSS. The real impact in unfavourable donor-recipient combination needs further investigations. A potential expansion of donors’pool is predictable with this innovative system.

1De Gasperis Cardio Center, Niguarda Milano

© 2018 Italian Federation of Cardiology. All rights reserved.