New Perfusion and Preservation Strategies for Donor Hearts.

BACKGROUND

Several systems for organ procurement and transportation are available in heart transplantation. Hypothermic storage of the cardioplegic heart has been the global standard since the 1980s and provides consistently reliable outcomes. However, ischemic time remains limited to approximately 4-5 h.

SUMMARY: Recent preservation strategies aim to extend ischemic tolerance. This has been demonstrated for both modified hypothermic systems (e.g., SherpaPak, VitalPack) and machine perfusion devices (e.g., OCS, XVIVO). Beyond clinical performance, system selection is strongly influenced by economic factors. While conventional hypothermic storage is fully reimbursed, the substantially higher costs of advanced systems are typically covered only within the framework of clinical studies or must be financed by transplant centers.

KEY MESSAGES: Hypothermic storage remains the standard method with proven long-term reliability, but is limited by restricted ischemic time. Novel preservation technologies extend ischemic tolerance and may improve transplantation logistics; however, their widespread implementation is currently limited by high costs and restricted reimbursement.