Machine perfusion for cardiac allograft preservation

PURPOSE OF REVIEW: The current cardiac preservation strategy for cardiac transplantation involves arresting hearts with a crystalloid preservation solution and storing them in this solution in an ice chest. This technique has allowed good results in heart transplantation, but has limited the transport interval, and has not encouraged major efforts to expand the donor pool. Machine perfusion of explanted organs, a technique used clinically in kidney transplantation, is now under active investigation in the cardiac arena. This review examines the current status of this technology. RECENT FINDINGS: Recent experimental studies in animals have tested machine perfusion for cardiac preservation. This technique appears to reduce the allograft ischemic burden, may permit longer preservation times, and improves early ventricular function upon reperfusion of the donor heart. The metabolic profile of the stored heart appears better preserved with machine perfusion; however, investigators have noted a risk of edema development in perfused cardiac grafts. SUMMARY: Early experimental results are encouraging and suggest that machine perfusion may offer superior cardiac performance after transplantation. In the future, this technology may lead to an expansion of the donor pool through greater use of expanded-criteria donors, resuscitation of ischemically injured hearts, or procurement of hearts that are donated after cardiac death.